宫颈癌漏诊的原因分析

发布时间：2018-10-14 12:37

【摘要】：目的:通过分析69例宫颈癌漏诊的原因,总结经验,以减少临床宫颈癌漏诊情况的发生。方法:回顾性分析吉林大学第二医院从2014年1月到2016年6月期间收治的69例宫颈癌患者的临床病理资料。这69例宫颈癌包括:因妇科其他疾病行全子宫切除术后发现为宫颈癌的患者7例;初次诊断为宫腔积脓的宫颈癌患者1例;阴道镜直视宫颈组织活检病理为HSIL或外院宫颈组织活检病理玻片经我院病理科会诊确诊为HSIL,行手术治疗,最后经术后病理确诊为宫颈癌患者61例。结果:1.69例宫颈癌的临床表现:31.9%接触性出血、13.0%阴道异常流血、8.7%白带异常、5.8%阴道排液、1.4%腰腹酸痛,但是有36.2%无临床症状。2.69例宫颈癌的体征:78.3%宫颈表面糜烂、17.4%宫颈表面光滑、18.8%宫颈肥大、5.8%子宫增大,只有2.9%宫颈有赘生物。3.45例宫颈癌行TCT检查,结果为6例(13.3%)NILM、8例(17.8%)ASC-US、17例(37.8%)ASC-H、2例(4.4%)LSIL、11例(24.4%)HSIL、1例(2.2%)不典型增生腺上皮。6例NILM中宫颈腺癌占83.3%。4.57例宫颈癌行HPV检测,结果为93.0%阳性、7.0%阴性。HPV阴性中宫颈腺癌占75.0%。5.69例宫颈癌均行经阴道超声检查,结果为13例提示宫颈回声不均,5例提示血流信号丰富,4例提示宫腔内异常回声,但是有47例(68.1%)无阳性发现。6.61例宫颈癌的宫颈活检结果:CINIII级20例;CINIII级累腺41例。7.61例宫颈活检为HSIL的宫颈癌中:39例行宫颈冷刀锥切术,锥切石蜡病理均为宫颈癌。其中29例宫颈锥切标本送冰冻病理,结果为8例CINIII级累腺、21例宫颈癌,锥切冰冻病理宫颈癌漏诊率为27.6%(8/29)。8.61例宫颈活检为HSIL的宫颈癌中:19例拒绝行宫颈冷刀锥切术,要求直接行全子宫切除术,子宫切除术后石蜡病理均为宫颈癌。其中11例子宫切除标本送冰冻病理,结果为7例CINIII级累腺、4例宫颈癌,全子宫切除冰冻病理宫颈癌漏诊率为63.6%(7/11)。9.61例宫颈活检为HSIL的宫颈癌中:3例拟行宫颈冷刀锥切术,术中见宫颈管内有菜花样组织流出,遂行宫颈管搔刮术,宫颈管搔刮组织送冰冻病理检查,结果均为(宫颈管)浸润性鳞癌,遂行宫颈癌根治术。值得注意的是3例超声均提示宫颈不同程度增大,回声不均。结论:1.宫颈癌患者的临床表现和体征有时无特异性。2.宫颈细胞学对宫颈癌的直接诊断准确性不高。3.HPV阴性时也可以发生宫颈癌。4.早期宫颈癌的超声多无阳性发现。5.宫颈组织活检对早期宫颈浸润癌诊断不足。6.宫颈冷刀锥切冰冻病理对宫颈癌的诊断有一定的局限性。
[Abstract]:Objective: to analyze the causes of missed diagnosis of 69 cases of cervical cancer and summarize the experience in order to reduce the incidence of missed diagnosis of clinical cervical cancer. Methods: the clinicopathological data of 69 patients with cervical cancer admitted from January 2014 to June 2016 in the second Hospital of Jilin University were retrospectively analyzed. The 69 cases of cervical cancer included: 7 cases of cervical cancer were found after total hysterectomy due to other gynecological diseases, 1 case of cervical cancer diagnosed as uterine cavity pus for the first time; HSIL or pathological slide of cervical biopsy in our hospital were diagnosed as HSIL, by colposcopy. Finally, 61 cases of cervical cancer were confirmed by postoperative pathology. Results: 1.The clinical manifestations of 69 cases of cervical cancer were 31. 9% of contact bleeding, 13. 0% of abnormal vaginal bleeding, 8. 7% of abnormal leucorrhea, 5. 8% of vaginal effusion, and 1. 4% of abdominal pain. But there were 36.2% no clinical symptoms. 2.69 signs of cervical cancer: 78.3% cervical surface erosion, 17.4% smooth cervical surface, 18.8% cervical hypertrophy, 5.8% uterine enlargement, only 2.9% cervical cancer have neoplasm. 3.45 cases of cervical cancer were examined by TCT. Results six cases (13.3%) of NILM,8, 37.8% (37.8%) of ASC-US,17, ASC-H,2 (4.4%), LSIL,11 (24.4%), HSIL,1 (2.2%) of atypical hyperplasia glandular epithelium, 83.3% (4.57) cases of cervical carcinoma were examined by HPV in 6 cases of NILM, the results were 93.0% positive, 7.0% negative, 75.0% of HPV negative, 75.0% of 5.69 cases of cervical carcinoma were examined by transvaginal ultrasound. The results showed that 13 cases showed abnormal echo in cervix, 5 cases showed abundant blood flow signal, 4 cases showed abnormal echo in uterine cavity. However, 47 cases (68.1%) were not found positive. The cervical biopsy results of 6.61 cases of cervical cancer were as follows: CINIII grade 20 cases, CINIII grade 41 cases. Among 7.61 cases of cervical carcinoma with HSIL biopsy, 39 cases were treated with cold knife conization of cervix and paraffin wax were all cervical carcinoma. Among them, 29 cases of cervical biopsy were sent to frozen pathology, the results were 8 cases of CINIII grade and 21 cases of cervical cancer. The rate of missed diagnosis of frozen cervical carcinoma was 27.6% (8 / 29). In 8.61 cases of cervical carcinoma with HSIL biopsy, 19 cases refused to undergo cervical cold knife conization. Direct hysterectomy is required. Paraffin wax pathology after hysterectomy is cervical cancer. Among them, 11 cases of hysterectomy specimens were sent to frozen pathology. The results were as follows: 7 cases of CINIII grade, 4 cases of cervical cancer. The rate of missed diagnosis of total hysterectomy frozen pathological cervical carcinoma was 63.6% (7 / 11). The cervical canal was scratched and curettage was performed during the operation. The results were invasive squamous cell carcinoma (cervical canal) and radical cervical cancer. It is worth noting that three cases of ultrasound showed that the cervix increased in varying degrees, and the echo was uneven. Conclusion: 1. Clinical manifestations and signs in patients with cervical cancer are sometimes nonspecific. 2. 2. The accuracy of cervical cytology in the direct diagnosis of cervical cancer is not high. When 3.HPV is negative, cervical cancer can also occur. 4. 4. Most of the early cervical cancer were found positive by ultrasound. 5. 5. Cervical biopsy for early invasive cervical carcinoma. 6. 6. The frozen pathology of cold knife conical resection of cervix has certain limitation in the diagnosis of cervical cancer.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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