宫颈腺上皮内瘤变的临床病例特点分析

发布时间：2018-07-09 13:59

本文选题：宫颈腺上皮内瘤变 + 宫颈细胞学　；参考：《首都医科大学》2017年硕士论文

【摘要】：【目的】探讨宫颈腺上皮内瘤变(cervical glandular intraepithelial neoplasia,CGIN)的临床病例特点。【方法】2002年1月至2015年12月在首都医科大学附属北京妇产医院住院治疗、并且病例资料完整的170例CGIN患者进行临床病例资料回顾性分析。【结果】(1)170例CGIN患者中,单纯CGIN患者37例(21.76%,37/170),合并鳞状上皮病变者133例(78.24%,133/170);低级别CGIN患者75例(44.12%,75/170),高级别CGIN患者95例(55.88%,95/170)。(2)170例CGIN患者中,宫颈细胞学检查有143例(84.12%,143/170)提示鳞状上皮细胞异常,仅24例(14.12%,24/170)提示腺细胞异常;单纯CGIN患者37例的宫颈细胞学检查提示腺细胞异常者17例(45.95%,17/37),而CGIN合并CIN患者的腺细胞异常者仅7例(5.62%,7/133),两者相比差异有统计学意义(p0.05);95例高级别CGIN患者中,有21例(22.11%,21/95)提示宫颈腺细胞异常,75例低级别CGIN患者中仅有3例(4.00%,3/75)提示宫颈腺细胞异常,高级别CGIN者发现宫颈细胞学异常明显高于低级别CGIN,两者相比差异显著(p0.05)。(3)170例患者中,通过阴道镜下宫颈活检诊断CGIN者60例(35.29%,60/170),因CIN行宫颈锥切术后发现CGIN者39例(22.94%,39/170),因CIN或其他子宫良性病变行子宫切除术后发现CGIN者71例(41.76%,71/170);37例单纯CGIN患者均通过宫颈活检诊断(100.0%,37/37),而133例CGIN合并CIN的患者中仅有23例(17.29%,23/133)通过宫颈活检诊断,两者相比,差异有统计学意义(p0.05);在95例高级别CGIN中,有54例(56.84%,54/95)是通过宫颈活检诊断,而75例低级别CGIN患者中,仅6例通过宫颈活检诊断,两者相比,差异有统计学意义(p0.05)。89例行宫颈锥切术的患者中,术前经宫颈活检诊断CGIN者17例(19.10%,17/89),其余72例(80.90%,72/89)为宫颈锥切术后诊断。【结论】1、CGIN常与CIN并存;2、宫颈细胞学筛查及阴道镜下宫颈活检对CGIN的检出率均较低;3、单纯CGIN的术前诊断率高于CGIN合并CIN;高级别CGIN的术前诊断率高于低级别CGIN;4、CGIN阴道镜下宫颈活检病理结果与宫颈锥切术或子宫切除术后病理结果的符合率较低;宫颈锥切术是诊断CGIN的主要方式。
[Abstract]:[objective] to investigate the clinical features of cervical intraepithelial neoplasia (cervical glandular intraepithelial neoplasia CGIN). [methods] from January 2002 to December 2015, we hospitalized in Beijing Maternity Hospital affiliated to Capital Medical University. The clinical data of 170 patients with CGIN were analyzed retrospectively. [results] (1) among 170 patients with CGIN, There were 37 cases (21.76c / 170) of CGINs, 133 cases of squamous epithelium lesions (78.24%), 75 cases of low-grade CGINs (44.12% 75 / 170), 95 cases of high-grade CGINs (55.88% -170%). (2), 143 cases (84.12%) of them showed squamous epithelial cell abnormalities. Only 24 cases (14.12 / 170) showed abnormal glandular cells. The cervical cytological examination of 37 patients with CGIN showed that 17 cases (45.95 / 37) had abnormal glandular cells, while only 7 cases (5.62% 7 / 133) had abnormal glandular cells in CGIN with cin. The difference between them was statistically significant (p0.05) in 95 cases of high grade CGIN. There were 21 cases (22.1111 / 95) indicating abnormal cervical adenocytes and only 3 (4.00% / 75) of 75 cases of low grade CGINs showed abnormal cervical glandular cells. High grade CGINs were significantly higher than low grade CGINs, and the difference was significant (p0.05). (3) in 170 cases. 60 cases of CGIN were diagnosed by cervical biopsy under colposcopy (35.29g / 170), 39 cases (22.9439 / 170) of CGIN were found after cin cervicotomy, 71 cases (41.7671 / 170) of CGIN were found after hysterectomy for cin or other benign uterine diseases. All 37 cases of simple CGIN passed through the cervix. And out of 133 cases of CGIN with cin, only 23 (17.29 / 133) were diagnosed by cervical biopsy. The difference was statistically significant (p0.05). In 95 cases of high grade CGIN, 54 cases (56.84% 54 / 95) were diagnosed by cervical biopsy, while in 75 cases of low grade CGIN, only 6 cases were diagnosed by cervical biopsy. The difference was statistically significant (p0.05) .89 patients undergoing cervical conization, 17 cases (19.10% 17 / 89) were diagnosed by cervical biopsy before operation, the other 72 cases (80.90) were diagnosed after cervix conization. [conclusion] 1CGIN often coexisted with cin. The detection rate of CGIN in cervical cytology and cervical biopsy under colposcopy was lower than 3 cases. The preoperative diagnosis rate of high grade CGIN was higher than that of low grade CGIN4 CGIN with cin, and the coincidence rate between the pathological results of cervical biopsy under CGIN4 and cervical conization or hysterectomy was lower than that of high grade CGIN. Cervical conization is the main way to diagnose CGIN.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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