宫颈上皮内瘤样病变Ⅲ级的治疗与预后分析_临床医学论文.docVIP

宫颈上皮内瘤样病变Ⅲ级的治疗与预后分析_临床医学论文 宫颈上皮内瘤样病变Ⅲ级的治疗与预后分析_临床医学论文 作者：冯笑丰，周才芳，黎肖梅 【关键词】 宫颈上皮内瘤样病变；宫颈原位癌；宫颈不典型增生 　　摘要：目的：探讨宫颈上皮内瘤样病变Ⅲ级（CIN Ⅲ）的治疗方法及其预后。方法：对1988年1月至2005年1月在我院治疗的CIN Ⅲ患者124例进行回顾性分析，其中宫颈原位癌48例，宫颈重度不典型增生76例。结果：原位癌患者中，行次广泛全子宫切除术的29例和全子宫切除术的11例，术后均无复发；6例行宫颈锥形切除术，1例术后9年再次发生原位癌；重度不典型增生的患者，49例行子宫切除术，27例行锥切术，术后患者均无复发。结论：全子宫切除术与次广泛全子宫切除术预后相近，全子宫切除术可作为原位癌患者的首选治疗方法，单纯宫颈锥切术有术后复发可能，术后应严密随访；重度不典型增生可行宫颈锥切术或LEEP手术，术后应定期随诊。 　　关键词：宫颈上皮内瘤样病变；宫颈原位癌；宫颈不典型增生 　　The Prognosis and Treatment of Cervical Intraepithelial Neoplasia Ⅲ 　　Abstract: Objective: To explore the prognosis and treatment of cervical intraepithelial neoplasia Ⅲ (CIN Ⅲ). Method: We analyzed 124 cases with CIN Ⅲ from Jan. 1988 to Jan. 2005. In all of them 48 cases with cervical carcinoma in situs 76 cases with cervical serious atypical hyperplasia. Result: In all with cervical carcinoma in situs, 29 cases underwent part hysterectomy, 11 cases underwent total hysterectomy. Theres no recurrence in all 6 cases taken cervical conization, one of them occurred cervical carcinoma in situs after 9 years. In the cervical serious atypical hyperplasia patients, 49 cases with total hysterectomy, 27 cases with cervical conization. Theres no reccurrence. Conclusion: Its similiar of the prognosis in total and part hysterectomy. Its the best to undergo total hysterectomy in cervical carcinoma in situ patients. Its possible to occure again with simply cervical conization. So its necessary to follow up. Its important to undergo cervical conization or with LEEP for the cervical senions atypical hyperplasia, and the terminal follow up is necessary. 　　Key words:CIN;Cervical carcinoma in situ;Cervical serious atypical hyperplasia;Treatment 　　宫颈上皮内瘤样病变Ⅲ级（CIN Ⅲ）临床预后较好，但由于术前活检与术后病理诊断之间有时有较大的差别，临床医生唯恐术后病理为浸润癌而术前未发现，故在决定手术方式时往往扩大手术范围，给患者造成过度治疗，所以有必要对CIN Ⅲ病例进行回顾性分析，总结一定的临床经验，以便在今后的临床工作中有所借鉴。 　　1资料与方法 　　1.1一般资料：我院自1988年1月至2005年1月共收治CIN Ⅲ患者124例，其中CINⅢ患者48例，占同期宫颈癌的38.71%（48／124）；重度不典型增生76例，占同期ⅢCIN患者61.29%（76／124）。患者平均年龄44.9岁（21～70岁），其中原位癌患者平均年龄48.2岁 （2