宫颈上皮内瘤变Ⅲ级在宫颈表面的分布特征

发布时间：2017-12-28 21:12

本文关键词：宫颈上皮内瘤变Ⅲ级在宫颈表面的分布特征　出处：《皖南医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨宫颈上皮内瘤变Ⅲ级(CINⅢ)在宫颈表面的分布特征。方法:选择2012.12-2014.12在我院就诊的细胞学诊断为HSIL或ASCU-H的398名患者行宫颈环形电切术(LEEP),将术后的宫颈组织按钟形切面连续的切成12部分,由2位病理科专家对每部分作出组织学诊断。其中197位患者被诊断为CINⅢ,并分为以下四组:A:单纯的CINⅢ(51例)、B:CINⅢ+CINⅡ(74例)、C:CINⅢ+CINⅡ+CINⅠ(50例)、D:CINⅢ+CINⅠ(22例)。记录患者年龄、性生活时间、人乳头瘤病毒(HPV)感染情况。利用统计学方法判断宫颈各点之间CINⅢ的发病有无差异及CINⅢ与HR-HPV感染、年龄、性生活的关系。结果:1.197位患者中,宫颈1-12点有CINⅢ病变的人数波动在53-81,10点最多,有81人,占患者总人数的41.11%(81/197);1点最低,53人,占患者总人数的26.90%(53/197),但各点之间总的差异无统计学意义(P0.05)。宫颈第四象限CINⅢ病变的人数最多,占患者总人数的56.85%(95/197);第三象限最少,占患者总人数的47.21%(93/197),四组之间差异无统计学意义(P0.05)。CINⅢ位于前唇的有134人,占患者总人数的68.02%;位于后唇的123人,占患者总人数的62.44%;位于左侧的126人,占患者总人数的63.96%;位于右侧的133人,占患者总人数的67.51%。四组间差异无统计学意义(P0.05),前唇与后唇、左侧与右侧差异无统计学意义(P0.05)。2.HR-HPV在CINⅢ中的感染率为87.82%,其中HPV16的感染率为57.87%,四组间比较总的差异无统计学意义(P0.05)。HPV16在≥5个点CINⅢ病变的患者中感染率最高,为68.29%(28/41),在只有一个点的患者中感染率最低,为50.00%,各组之间总的差异无统计学意义(P0.05);3.患者的平均年龄为43.70±9.94岁,主要位于41-45岁年龄段,占总人数的30.96%。A组年龄大于45岁的人数最多,占49%,B组年龄多在41-45岁,占40.5%,C组年龄多在36-40岁,占38%,D组年龄多在41-45岁占45.5%。各组年龄比较有统计学意义(P0.001)。在大于45岁的患者中,A组所占比率最高,为49.02%(25/51),C组所占的比率最低,为16%(8/50)。四组之间比较差异有统计学意义(P0.05),A组与B组、C组、D组比较差异分别有统计学意义(P0.05),而B组、C组、D组间均无统计学意义(P0.05);4.患者多有16-20年性生活,占总人数的37.06%(73/197)。A组中性生活大于20年的患者所占比率最大,为43.14%(22/51),D组最低18.18%(4/22),四组之间差异有统计学意义(P0.05),其中A组与B组、C组、D组比较分别有统计学意义(P0.05),而B组、C组、D组间均无统计学意义(P0.05)。5.A组中≥5个点CINⅢ病灶的患者最多,占37.30%;B组中有3个点CINⅢ病灶的患者人数最多,占27.00%;C组中有1个点CINⅢ病灶的患者人数最多,占32.00%;D组中有4个点CINⅢ病灶的患者人数最多,占36.41%。在CINⅢ病变≥5点的患者中,A组所占比率最高(46.34%),而且≥5个点病变的患者在单纯的CINⅢ中所占的比率最高(37.25%),与其他三组比较差异分别有统计学意义(P0.05)。结论:1.CINⅢ在宫颈表面随机分布;2.HPV16感染与CINⅢ病变大小无关;3.单纯的CINⅢ更可能有较大的病变、更长的性生活史、较大的年龄、更有可能进展到宫颈癌。
[Abstract]:Objective: To investigate the distribution of cervical intraepithelial neoplasia (CIN III) on the cervical surface. Methods: 398 patients who were diagnosed as HSIL or ASCU-H diagnosed by 2012.12-2014.12 in our hospital were treated by cervical loop electrosurgical excision procedure (LEEP). The cervical tissue was cut into 12 parts continuously according to the bell shaped section. Histological diagnosis was made by 2 Pathological experts. 197 patients were diagnosed as CIN III and divided into the following four groups: A: simple CIN III (51 cases), B:CIN III +CIN II (74 cases), C:CIN III +CIN II +CIN I (50 cases), D:CIN III +CIN I (22 cases). The age of the patients, the time of sexual life, and the infection of human papillomavirus (HPV) were recorded. The statistical method was used to determine the difference in the incidence of CIN III between the cervical points and the relationship between CIN III and HR-HPV infection, age and sexual life. Results: among the 1.197 patients, the number of patients with CIN III lesions at the 1-12 points of the cervix fluctuated at the most 53-81,10 point, 81 people, accounting for 41.11% of the total number of patients (81/197), 1 points were the lowest, 53 people accounted for 26.90% (53/197) of the total number of patients, but the total difference between the points was not statistically significant (P0.05). The number of cervical fourth quadrant CIN III lesions was the largest, accounting for 56.85% (95/197) of the total number of patients. The third quadrant was the least, accounting for 47.21% (93/197) of the total number of patients. There was no significant difference between the four groups (P0.05). CIN III had 134 people on the front lip, accounting for 68.02% of the total number of patients, 123 people in the posterior lip accounted for 62.44% of the total number of patients, 126 on the left side, 63.96% of the total number of patients, 133 on the right side, accounting for 67.51% of the total number of patients. There was no statistically significant difference between the four groups (P0.05). There was no significant difference in the difference between the anterior lip and the posterior lip, the left and right side (P0.05). The infection rate of 2.HR-HPV in CIN III was 87.82%, of which the infection rate of HPV16 was 57.87%. There was no significant difference in the total difference between the four groups (P0.05). HPV16 in more than 5 points in CIN III lesions in patients with the highest infection rate was 68.29% (28/41), at only one point in patients with the lowest infection rate was 50%, and there was no significant difference between groups in total (P0.05); the average age of 3. patients was 43.70 + 9.94 years, mainly in the 41-45 years age, accounting for 30.96% of the total number. In group A, the number of people older than 45 years was the most, accounting for 49%. The age of group B was 41-45 years old, accounting for 40.5%. The age of group C was 36-40 years old, accounting for 38%. The age of group D was 45.5% in 41-45 years. The age of each group was statistically significant (P0.001). Among the patients older than 45, the A group accounted for the highest rate of 49.02% (25/51), and the C group had the lowest rate of 16% (8/50). The difference between the four groups was statistically significant (P0.05), and the difference between A group and B group, C group and D group was statistically significant (P0.05), while B group, C group and D group had no statistical significance (P0.05); 4. patients had 16-20 years of sexual life, accounting for 37.06% (73/197) of the total number. A group of more than 20 years of sexual life in patients accounted for the largest proportion, 43.14% (22/51), D group (4/22), a minimum of 18.18% statistically significant differences between the four groups (P0.05), A group and B group, C group and D group were statistically significant (P0.05), and B group C group and D group had no statistical significance (P0.05). Group 5.A = 5 CIN III lesions of most patients, accounted for 37.30%; the number of patients with 3 CIN lesions of the most, accounted for 27% in the B group; a number of patients 1 CIN III lesions most, accounted for 32% in the C group; the number of patients with 4 CIN lesions of the most in the D group, accounting for 36.41%. More than 5 points in CIN III lesions in patients with A group, the highest percentage (46.34%), and the highest rate of less than 5 in patients for pure CIN III in (37.25%), and the difference between the three groups were statistically significant (P0.05). Conclusion: 1.CIN III is distributed on the cervical surface randomly. 2.HPV16 infection has nothing to do with the size of CIN III lesion. 3., simple CIN III is more likely to have larger lesions, longer sexual life history, larger age, and more likely to progress to cervical cancer.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.33

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