[1]付亚娟,刘 娟,申 艳.宫颈原位腺癌32例临床诊断分析[J].南京师范大学学报(自然科学版),2018,41(04):120.[doi:10.3969/j.issn.1001-4616.2018.04.019]
　Fu Yajuan,Liu Juan,Shen Yan.The Analysis of Clinical Diagnosis of CervicalAdenocarcinoma in Situ of 32 Cases[J].Journal of Nanjing Normal University(Natural Science Edition),2018,41(04):120.[doi:10.3969/j.issn.1001-4616.2018.04.019]
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宫颈原位腺癌32例临床诊断分析()
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《南京师范大学学报》（自然科学版）[ISSN:1001-4616/CN:32-1239/N]

卷:
第41卷
期数:
2018年04期
页码:
120
栏目:
·生命科学·
出版日期:
2018-12-31

文章信息/Info

Title:
The Analysis of Clinical Diagnosis of CervicalAdenocarcinoma in Situ of 32 Cases
文章编号:
1001-4616(2018)04-0120-05
作者:
付亚娟; 刘 娟; 申 艳
南京医科大学附属妇产医院,江苏 南京 210004
Author(s):
Fu Yajuan; Liu Juan; Shen Yan
Women’s Hospital of Najing Medical University,Nanjing 210004,China
关键词:
AIS; 宫颈细胞学; 高危型HPV; 诊断; 阴道镜; 宫颈活检; 宫颈锥切
Keywords:
cervical adenocarcinoma in situ; cytologic screening; High-risk HPV; diagnosis; colposcopy; biopsy; cervical conization
分类号:
R711
DOI:
10.3969/j.issn.1001-4616.2018.04.019
文献标志码:
A
摘要:
探讨宫颈原位腺癌(adenocarcinoma in situ,AIS)的诊疗思考. 回顾性分析南京市妇幼保健院2014年 1月-2017年12月收治的32例宫颈原位腺癌患者的临床表现、诊断方法、手术方式及病理结果. 患者平均年龄(42.75±7.81)岁,其中9例有阴道出血、8例有同房出血、21例存在细胞学异常、23例呈现HPV阳性,其中HPV16、18、45阳性的有14例,有个别患者同时存在两种HPV阳性,已生育的有29例,未生育的3例. 活检发现AIS 16例,锥切或LEEP发现AIS有13 例,全子宫切除术后发现AIS有3例. 治疗:32例患者中6例患者直接行全子宫切除+双附件切除和(或)盆腔淋巴结清扫,余患者均行宫颈锥切明确病理后处理,共29例行全子宫切除术,术后病理:8例术后病理AIS,5例患者术后病理腺癌,1例术后病理AIS,疑有微浸润性癌,2例术后病理灶性上皮不典型增生,2例术后病理AIS及局灶微浸润癌,2例术后病理CIN1-2级,1例术后病理灶性CIN3级,1例术后病理AIS及CIN2-3级,7例术后病理慢性宫颈炎. 所有患者均未发现转移癌. 术后随访4～48月至今未发现复发病例. 其中3例患者选择了保守性治疗—宫颈锥切术,1例LEEP术后发现AIS,切缘AIS,第二次CKC术后病理小灶CIN2级,切缘阴性,1例患者活检AIS行CKC术后病理慢性宫颈炎小灶符合CIN2级,切缘阴性,1例患者活检病理AIS疑有浸润癌,第一次CKC术后病理AIS,病变距离宫颈管外口切缘最近处约2 mm,第二次CKC术后病理慢性炎,少部分腺体示轻度不典型增生,病变腺体距离宫颈内口切缘最近处约2 mm. 这3例患者均有生育要求严密随访中. 结果显示,鉴于宫颈细胞学筛查和高危型HPV敏感性较低、阴道镜检查图像改变轻微、病变大小及位置、跳跃性病变、深部病变、混合型病变等因素均会影响AIS的发现和处理. 因此临床工作中对于AIS的诊断我们既要结合细胞学、HPV综合分析,同时作为阴道镜医师又要不断提高识别腺上皮病变的能力和临床警惕性,避免AIS漏诊,从而尽可能避免子宫颈腺癌的发生.
Abstract:
To investigate the clinical diagnostic strategy and treatment method of cervical adenocarcinoma in situ(AIS). The clinical manisestations,diagnostic methods,surgical methods and pathological findings of thirty two cases of cervical adenocarcinoma in situ who treated in our hospital from 2014 to 2017 were analyzed retrospectively. The mean age of the patients was(42.75±7.81)years old,and nine cases showed irregular vaginal bleeding,eight cases showed contact bleeding,twenty one cases had abnormal glandular epithelial cell or squamous epithelial cells,and twenty three cases had high-risk Human Papilloma Virus(HPV)positive(fourteen cases were HPV16、18、45 positive; some of them had two HPV types positive). Twenty nine cases had child/children,three cases had no child. Through out biopsy/endocervical curettage under colposcopy,sixteen cases were diagnosed as AIS,thirteen cases underwent cervical conization and the pathological findings were AIS. Three cases were diagnosed AIS after hysterectomy. Treatment:Of thirty-two patients,six cases underwent directly whole hysterectomy with appendix resection and(or)pelvic lymph node resection,others were performed cervical conization and through out the pathological findings to decide the next clinical operation. A total of twenty nine underwent total hysterectomy,postoperative pathology:eight cases of postoperative pathology AIS,five patients with postoperative pathological cervical adenocarcinoma,one case AIS with suspected micro invasive carcinoma,two cases had focal epithelial dysplasia,two cases were AIS and focal micro infiltrating carcinoma,two cases were CIN1-CIN 2,one case was focal CIN3,one case was AIS combined with CIN2 -CIN3,seven cases just were chronic cervicitis. Metastatic carcinoma was not found in all patients. No recurrence was found during four-forty eight months of postoperative follow-up. Three of the patients chosed conservative treatment of cervical conization,one case of Loop electrosurgical excision(LEEP)surgery found that AIS,conization margin was AIS,the second postoperative pathological of Cold-Knife Conization(CKC)showed CIN2,negative margins,one AIS case diagnosed by biopsy underwent CKC werel chronic cervicitis combined with CIN2,negative margin,one case diagnosed by biopsy of AIS patients with suspected invasive cancer,the first CKC showed AIS,the lesion from the margin recently was about two mm,after the second CKC,postoperative pathologyshowed chronic inflammation,a small gland in mild atypical hyperplasia,pathological glands intracervical margin was about two mm. All the three patients had fertility requirements and were in follow-up. In view of the low sensitivity of cervical cytologic screening and high-risk HPV,slight changes in colposcopy images,lesion size and location,jumping lesions,deep lesions,mixed lesions and other factors will affect the discovery and treatment of AIS. Therefore,the diagnosis of AIS in clinical work should be combined with the comprehensive analysis of cytology and HPV,and at the same time,as a vaginal speculator,we should constantly improve the ability and clinical vigilance to identify adenoepithelial lesions and avoid AIS misdiagnosis,so as to avoid the occurrence of cervical adenocarcinoma as much as possible.

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备注/Memo

备注/Memo:
收稿日期:2018-01-20.
基金项目:江苏省卫生厅资助项目(F201440).
通讯联系人:申艳,主任医师,硕士生导师,研究方向:宫颈病变及外阴疾病. E-mail:shenyanfy@163.com
更新日期/Last Update: 2018-12-30