70例宫颈原位腺癌患者临床特征及诊断

Clinical Features and Diagnosis of 70 Patients with Cervical Adenocarcinoma in Situ

摘要: 目的：对70例经宫颈冷刀锥切术诊断为宫颈原位腺癌患者进行临床特征分析，为宫颈原位腺癌诊断提供参考。方法：对2016年1月至2020年7月于青岛大学附属医院收治的70例经宫颈锥切及LEEP术术后病理诊断为宫颈原位腺癌(adenocarcinoma in situ, AIS)的患者进行回顾性分析其临床症状、HPV检查结果、宫颈液基细胞学(TCT)检查结果、阴道镜活检及宫颈锥切病理结果进行分析。结果：共有70例患者纳入本研究，发病年龄在28~70岁，平均年龄41.34 ± 7.84岁；无症状患者46例(65.7%)，接触性出血患者14例(20%)，阴道分泌物异常患者6例(8.6%)，异常阴道流血患者4例(5.7%)；宫颈HPV分型阳性率88.2%，TCT阳性率79.2%，其中腺细胞异常阳性率5.2%；阴道镜宫颈活检阳性患者有46例，其中单纯AIS 22例(31.4%)，AIS合并CIN (I~III)级27例(38.6%)，HSIL 20例(28.6%)，炎症1例(1.4%)，宫颈锥切病理结果为单纯AIS患者35人，AIS合并HSIL患者28人，AIS合并LISL患者7人。结论：宫颈原位腺癌起病较隐匿，因此单纯依靠临床症状与临床检查很难明确诊断。HPV检测与细胞学联合筛查有助于AIS的早期发现。阴道镜下宫颈多点活检有助于提高AIS诊断率，宫颈锥切组织病理活检是确诊AIS的主要方法。

Abstract: Objective: The clinical characteristics of 70 patients diagnosed with cervical adenocarcinoma in situ by cold knife conical resection were analyzed to provide reference for the diagnosis. Methods: Seventy cases of adenocarcinoma in situ of the cervix were pathologically diagnosed after cervical conical resection and LEEP in Affiliated Hospital of Qingdao University from January 2016 to July 2020. Clinical symptoms, HPV test results, cervical fluid based cytology (TCT) test results, colposcopy biopsy and cervical conical biopsy results were retrospectively analyzed. Results: A total of 70 patients were included in this study. The onset age ranged from 28 to 70 years, with an average age of 41.34 ± 7.84 years. There were 46 asymptomatic patients (65.7%), 14 contact bleeding patients (20%), 6 abnormal vaginal discharge patients (8.6%), and 4 abnormal vaginal bleeding patients (5.7%). The positive rate of cervical HPV typing was 88.2%, the positive rate of TCT was 79.2%, and the positive rate of adenosine cell abnormality was 5.2%. There were 46 patients with positive cervical biopsy under colposcopy, including 22 patients with simple AIS (31.4%), 27 patients with AIS combined with CIN (I~III) grade (38.6%), 20 patients with HSIL (28.6%), and 1 patient with inflammation (1.4%). The pathological result of cervical conical resection was simple AIS in 35 patients. There were 28 patients with AIS combined with HSIL, and 7 patients with AIS combined with LISL. Conclusion: Adenocarcinoma in situ of cervix is insidious, so it is difficult to make a definite diagnosis only by clinical symptoms and clinical examination. The combination of HPV testing and cytology screening contributes to the early detection of AIS. Cervical multipoint biopsy under colposcopy is helpful to improve the diagnosis rate of AIS, and cervical conical biopsy is the main method to diagnose AIS.