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目的评价TCT检查、阴道镜活检和宫颈冷刀锥切术(CKC)在高级别宫颈上皮内瘤变(CIN)诊断中的价值,并比较CKC及子宫全切术治疗高级别CIN的效果。方法收集2007年1月~2012年1月TCT、阴道镜下活检、CKC或子宫全切术后病例的临床病理资料,对不同诊治手段和CIN病理分级转化进行对比分析。结果经TCT、阴道镜活检病理证实高级别CIN 376例,行CKC248例,行子宫全切术128例,CKC与全切术前与术后分级一致率、分级上升率和分级下降率分别为52.02%,45.31%,3.22%,1.56%,44.76%,53.13%。两组患者平均随访2年,CKC 248例复发6例(2.42%),子宫全切128例复发1例(0.78%),差异无统计学意义(P=0.2500)。结论 TCT和阴道镜活检是诊断高级别CIN的有效手段,对年轻要求保留生育功能的高级别CIN患者,CKC是安全且有效的方法 ,对无生育要求的中老年高级别CIN患者全子宫切除是最好的治疗方法 ,两种术式两年复发率差异无统计学意义。
Objective To evaluate the value of TCT examination, colposcopy biopsy and cervical cold knife conization (CKC) in the diagnosis of high grade cervical intraepithelial neoplasia (CIN) and to compare the effect of CKC and hysterectomy in the treatment of high grade CIN. Methods The clinical and pathological data of TCT, colposcopy biopsy, CKC or total hysterectomy from January 2007 to January 2012 were collected and compared between different diagnosis and treatment methods and pathological grade and transformation of CIN. Results TCT and colposcopy biopsy confirmed high grade CIN in 376 cases, CKC in 248 cases and total hysterectomy in 128 cases. The preoperative and postoperative consistency between CKC and total resection, the grade increase rate and the grade decrease rate were 52.02 %, 45.31%, 3.22%, 1.56%, 44.76%, 53.13%. The two groups were followed up for an average of 2 years. 248 cases of CKC relapsed in 6 cases (2.42%), 128 cases of uterine recurrence in 1 case (0.78%), the difference was not statistically significant (P = 0.2500). Conclusion TCT and colposcopy biopsy is an effective method for the diagnosis of high-grade CIN. CKC is a safe and effective method for young patients with high-grade CIN who require reproductive function. Hysterectomy for high-grade CIN patients without fertility is The best treatment, two surgical two-year recurrence rate difference was not statistically significant.