阴道镜联合宫颈锥切对宫颈癌的诊断价值研究  

Colposcope Combined with Cervical Conization for the Early Diagnosis of Cervical Cancer

作　　者：曹树军[1] 施华珍[1] 朱春梅[1] 金艳[1] 原玮[1] 杨道华[2] 钱金风[1] 

机构地区：[1]上海交通大学附属第一人民医院松江分院妇产科,上海市201600 [2]上海交通大学附属第一人民医院松江分院病理科,上海市201600

出　　处：《中国全科医学》2013年第4期396-398,共3页Chinese General Practice

基　　金：上海市松江区医学领先专业建设项目(QW20090206)

摘　　要：目的探讨阴道镜活检与宫颈锥切联合应用对宫颈癌的早期诊断价值。方法收集我院2005年1月-2011年12月经病理诊断的高级别宫颈上皮内瘤变（CINⅡ、Ⅲ）和宫颈癌病例604例作为研究对象，回顾分析临床病理资料。结果阴道镜活检诊断宫颈低级别病变35例，CINⅡ306例，CINⅢ189例，宫颈浸润癌74例；CIN病例接受宫颈锥切371例，发现宫颈浸润癌19例；直接全子宫切除49例，发现宫颈浸润癌5例；部分CINⅢ锥切后补充全子宫切除未再发现病变升级病例；阴道镜活检诊断高级别CIN的准确率为61．6％（237／385），其中CINⅡ53．9％（123／228），CINⅢ72．6％（114／157），阴道镜活检漏诊宫颈浸润癌24例（均为早期浸润癌），阴道镜活检分别诊断为宫颈低级别病变1例，CINⅡ2例，CINⅢ21例，不同病变级别漏诊率间差异有统计学意义（X^2=27．537，P〈0．01）；阴道镜联合宫颈锥切诊断宫颈浸润癌93例，占94．9％，且80．6％（75／93）为早期浸润癌。结论阴道镜联合宫颈锥切可实现宫颈癌的正确诊断和早期诊断，并避免隐匿性宫颈癌的漏诊。Objective To evaluate the value of colposcopy combined with cervical conization for the early diagnosis of cervical cancer. Methods A total of 604 cases who were diagnosed with high grade cervical intraepithelial neoplasia （ CIN Ⅱ, Ⅲ ） or cervical cancer by pathology in our hospital between January 2005 to December 2011 were collected. Their clinical pathological data were retrospectively studied. Results Colposcopy and biopsy suggested 35 cases of low - grade cervical lesions, 306 cases of CIN Ⅱ , 189 cases of CINⅢand 74 cases of invasive cervical carcinoma （ICC）. A total of 371 cases of CIN received cervical conization, and 19 cases were diagnosed as ICC; 49 CIN cases received hysterectomy, and 5 cases of ICC were found. Some CIN Ⅲ cases were further treated with hysterectomy after cervical conization, and no upgraded cases were found. The accuracy rate of colposcopy and biopsy in detecting high grade CIN was 53.9% （123/228） and 72. 6% （114/157） for CIN Ⅱ and CIN Ⅲ, respectively. Twenty - four cases of ICC were missed in the diagnosis by colposcopy and biopsy, and they were diag- nosed as 1 case of low - grade cervical lesions, 2 cases of CIN Ⅱ and 21 CIN Ill. The higher the lesion grade, the higher the rate of missed diagnosis （ P 〈 0.01 ）. Ninety - three cases of ICC were detected by colposcopy combined with cervical conization with the detection rate of 94. 9%, and 80. 6% （75/93） of them were early invasive carcinoma. Conclusion Colposcopy combined with cervical conization has the potential to provide accurate and early diagnosis, and can avoid missed diagnosis of concealed cervical cancer.

关 键 词：宫颈癌 宫颈上皮内瘤变 阴道镜检查 宫颈锥切 

分 类 号：R713.44[医药卫生—妇产科学]