锥切术后早期阴道镜检查对处理切缘阳性患者的临床价值  

Colposcopy as a safety assessment method for follow-up of patients with positive excision margin after cervical conization

作　　者：彭晶晶[1] 尤志学 

机构地区：[1]南京医科大学第一临床医学院,南京210029 [2]南京医科大学第一附属医院妇科,南京210036

出　　处：《现代妇产科进展》2014年第10期790-793,共4页Progress in Obstetrics and Gynecology

摘　　要：目的：通过对高级别宫颈上皮内瘤变（ CIN）锥切后切缘阳性的患者术后4~6周行阴道镜检查,探讨阴道镜检查对处理切缘阳性患者的临床价值。方法：选取2012年1月至2012年12月在南京医科大学第一附属医院宫颈病中心就诊并行宫颈环形电切术（ LEEP）的CINⅡ~Ⅲ且切缘阳性的80例患者,术后4~6周均行阴道镜检查（接受活检或颈管掻刮）,其中未发现异常者71例（研究组）,9例≥CINⅠ病变残留；切缘阴性者137例（对照组）。研究组与对照组均于LEEP术后6个月复诊以评估病变残留。结果：（1）切缘阳性的80例患者中,锥切术后初次阴道镜检查发现9例≥CINⅠ病变残留,接受再次锥切或全子宫切除,最终发现3例CINⅠ、5例CINⅡ~Ⅲ及1例宫颈浸润癌。（2）术后6个月HR-HPV检测阳性47例中,病变残留6例；宫颈细胞学检查≥ASCUS 18例中,病变残留3例；HR-HPV、宫颈细胞学检测病变残留的敏感性分别为100%、50%,特异性为79.70%、91.35%。（3）对照组、研究组的病变残留率分别为2.19%（3/137）、4.23%（3/71）,两组比较差异无统计学意义（P〈0.05）。（4）锥切术后4~6周行阴道镜检查对切缘阳性患者病灶残留的阴性预测值为95.77%（68/71）,且无一例病理升级或浸润癌的发现。结论：术后早期阴道镜检查对锥切切缘阳性者具有可行性及实用性,不仅能及时发现病变残留并得以及时处理,且有较高的阴性预测价值,检查结果阴性者随访安全性高。Objective：To investigate clinical value of early colposcopy for patients with positive excision margin 4~6 weeks after cervical conization. Methods：To analysis the patients who were diagnosed CINII~Ⅲ by LEEP in cervical disease center,Department of Obstetrics and Gynecology,the first Affiliated Hospital of Nanjing Medical University, from Jan. to Dec. 2012 . All patients with positive excision margin got screened for colposcopy 4 ~6 weeks after cervical conization. Patients who were found residual disease at colposcopy directly received fur-ther treatment. 71 cases with positive excision margin who were not found residual disease at colposcopy 4~6 weeks after cervical conization （ study group） and 137 cases with negative ex-cision margin （ control group） were all followed up 6 months after conization for assessment of residual disease. Results：（1）9 of all 80 cases with positive excision margin were found residual disease at colposcopy for the first time after conization. These 9 patients received recurrent conization or hysterectomy and finally 3 cases of CINⅢ,5 cases of CINII~Ⅲ,1 case of cervi-cal invasive cancer were confirmed for residual disease. （2）47 patients＇HR-HPV detections 6 months after conization were positive;among these 47 cases,6 cases had residual disease. 18 pa-tients＇cervical cytology detections were positive;among these 18 cases,3 cases had residual dis-ease. The accuracy was 100% and specificity was 79. 7% in the detection of HR-HPV;the ac-curacy was 50% and specificity was 91. 35% in the detection of cervical cytology. （3）Residual lesions were found in 3 of the 137 （2. 19%） control group and 3 of 71 （4. 23%） study group, the difference was not statistically significant （ P〈0 . 05 ） . （ 4 ） The negative predictive value of colposcopy 4~6 weeks after cervical conization for residual disease of patients with positive ex-cision margin was 95. 77% （68/71）. Conclusions：Early colposcopy after cervical conization is feasible and practical fo

关 键 词：宫颈上皮内瘤变 宫颈锥切术 阴道镜检查 切缘 

分 类 号：R711.74[医药卫生—妇产科学]