阴道镜下宫颈活组织检查诊断孕妇宫颈病变的临床研究  

Clinical study on cervix biopsy guided by colposcopy in diagnosis of cervical diseases in pregnant women

作　　者：王彤[1] 吴玉梅[1] 宋芳[1] 朱力[2] 李宝珠[2] 郝霞[1] 孔为民[1] 段微[1] 范玲[3] 张为远[3] 

机构地区：[1]首都医科大学附属北京妇产医院妇瘤科,100006 [2]首都医科大学附属北京妇产医院病理科,100006 [3]首都医科大学附属北京妇产医院产科,100006

出　　处：《中华妇产科杂志》2010年第7期497-500,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：北京市科技计划（190906008040391）

摘　　要：目的 探讨阴道镜下宫颈活组织检查（活检）诊断孕妇宫颈病变的临床价值和安全性.方法 采用队列研究方法,选择2007年8月1日至2009年2月28日在北京妇产医院产科门诊初次检查的孕13～34周、1年内未进行过宫颈液基薄层细胞学检查（TCT）的孕妇,先进行TCT筛查,对TCT结果异常者,在知情同意后进行阴道镜检查和阴道镜下宫颈活检.结果 （1）TCT：TCT筛查孕妇共计17 828例,其中TCT结果异常1502例,发生率为8.425%.（2）阴道镜检查：204例孕妇进行了阴道镜检查.阴道镜图像满意度为92.6%（189/204）,阴道镜拟诊宫颈炎或宫颈上皮内瘤变（CIN）Ⅰ 125例,CIN Ⅱ25例,CIN Ⅲ或宫颈鳞状细胞癌（SCC）54例.（3）阴道镜下宫颈活检病理结果：204例行阴道镜检查者全部进行了宫颈活检,病理结果为宫颈炎及宫颈湿疣共33例,CIN Ⅰ 95例、CIN Ⅱ28例、CIN Ⅲ36例（包括宫颈原位癌13例）、SCC Ⅰ a期12例.（4）符合度：与宫颈活检病理结果比较,阴道镜检查拟诊炎症和CIN Ⅰ 125例,其中113例与宫颈活检病理结果相同,符合率为90.4%（113/125）,125例炎症和CIN Ⅰ患者中无一例病理结果为SCC.阴道镜检查拟诊CIN Ⅲ或SCC共54例中,23例活检病理结果为CIN Ⅲ、10例为SCC Ⅰ a期,符合率为61.1%（33/54例）.（5）并发症：阴道镜检查及宫颈活枪后,8例孕妇因宫颈局部压迫止血无效行创面缝合止血,发生率3.9%（8/204）,未发生其他与阴道镜检查和宫颈活检相关的不良事件.结论 对1年内未进行宫颈细胞学筛杏的孕妇进行TCT检查是必要的,对TCT结果异常者应进行阴道镜检查,阴道镜检查拟诊宫颈炎或CIN Ⅰ者可以随诊,对阴道镜检查拟诊CIN Ⅱ及更高级别宫颈病变的孕妇,应行阴道镜下宫颈活检以明确病理学诊断.Objective To investigate the value and safety of biopsy guided by colposcopy in diagnosis of cervical diseases in pregnant women.Methods From Aug.2007 to Feb.2009.17 828 pregnant women who receive antenatal examination underwent cervical cytological screening thinprep cytology test（TCT）in Beijing Obstetrics and Gynecology Hospital.If abnormal cytological results were found,those preguant women were administered by eolposcopic examination and biopsy after they signed informed consent.Results （1）TCT：the abnormal TCT results of 1502 preguant women（8.425%,1502/17 828） were found in 17 828 cases.（2）Colposeopie examination：two hundred and four pregnant women underwent colposcopic examination.The rate of satisfied colposcopic imaging wag 92.6%（189/204）,colposcopic examination identified 125 cages with cervical inflammation or cervical intraepithelial neoplasia （CIN）Ⅰ,25 cases with CIN Ⅱ and 54 cases with CIN Ⅲ or microinvasive squamous carcinoma （MIVC） of squamous cervical carcinoma（SCC）.（3）The results of biopsy guided by colposcopy：among 204 cases,it was found 33 cases with cervical inflammation or wart,95 cases with CIN Ⅰ,28 CIN Ⅱ,36 cases with CIN Ⅲ and 12 cases with MIVC. （4） The rate of concordance： compared with biopsy pathologic examination, colposcopy examination found 113 cases with cervical inflammation and CIN Ⅰ , the rate of concordance was 90. 4%（113/125）. And 54 cases with CIN Ⅲ or SCC diagnosed by colposcopy examination, however biopsy pathologic examination confirm 23 cases with CIN % and 10 cases with SCC at stage Ⅰ a, the concordance rate was 61% （33/54）. （5） Complication： eight （3.9%, 8/204） pregnant women underwent cervical wound suturing due to continuous bleeding after colposcopy exam or biopsy. No other complications were recorded. Conclusions It is necessary that TCT should be performed in pregnant women without cytological screening within one year. Colposcopic examination and biopsy were indicated if pregnant wo

关 键 词：妊娠并发症 宫颈上皮内瘤样病变 宫颈肿瘤 阴道镜检查 活组织检查 

分 类 号：R737.33[医药卫生—肿瘤]