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[宫颈涂片和刮宫术后宫颈上皮内瘤变的冷冻手术治疗]

[Cryosurgical treatment of cervical intraepithelial neoplasia following cervical smears and curettage].

作者信息

Hopp A, Hopp H, Heinrich J, Buchholz A

出版信息

Zentralbl Gynakol. 1986;108(11):659-64.

PMID:3751374
Abstract

65 patients exhibiting colposcopically and cytologically atypical epithelium in the cervix were treated by cryosurgery with liquid nitrogen. 63 of whom were confirmed histologically after surface scraping and curettage of the cervix. The patient then were followed cytologically and colposcopically 8 and 12 weeks after cryosurgery. According to that the definitive histological diagnosis was performed after conization (48 patients) hysterectomy (12 patients) and surface scraping and curettage of the cervix (8 patients). Colposcopical, cytological and histological findings after surface scraping of the cervix showed a correlation rate in the 95% range. Treatment failure rate following cryosurgery showed an increased percentage with increased grade of CIN. A complete destruction of ectocervical pathologic tissue in CIN 1 and 2 is opposed to a persistent disease rate of 20 percent in patients with CIN 3. The failure rate was significantly higher in cases without fully visualization of squamocolumnar junction. Cytological follow-up predicted all cases with histologic diagnosis of persistent disease. Colposcopical evaluation was frequently unsatisfactory after cryosurgery. Cryosurgery of CIN should be reserved for the treatment of those patients in whom the criteria for patient selection are performed and the benefits of this method outweigh the possible drawbacks.

摘要

65例经阴道镜和细胞学检查显示宫颈上皮不典型的患者接受了液氮冷冻治疗。其中63例在宫颈表面刮除和刮宫后进行了组织学确诊。然后在冷冻治疗后8周和12周对患者进行细胞学和阴道镜随访。根据情况,在锥形切除术(48例)、子宫切除术(12例)和宫颈表面刮除及刮宫术后(8例)进行了明确的组织学诊断。宫颈表面刮除后的阴道镜、细胞学和组织学检查结果显示相关率在95%左右。冷冻治疗后的治疗失败率随着CIN分级的增加而上升。CIN 1和2级患者宫颈外病理组织完全被破坏,而CIN 3级患者的持续病变率为20%。在鳞柱交界未完全可视化的病例中,失败率显著更高。细胞学随访可预测所有组织学诊断为持续性病变的病例。冷冻治疗后阴道镜评估常常不令人满意。CIN的冷冻治疗应仅用于那些符合患者选择标准且该方法的益处大于可能弊端的患者的治疗。

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