阴道镜异常图像、阴道镜直视下活体组织检查和宫颈环形电切术活体组织检查在宫颈上皮内瘤变诊断中的价值  

Value of abnormal colposcopic findings,colposcopic biopsy,and loop electrical excision procedure biopsy in diagnosis of cervical intraepithelial neoplasia

作　　者：李芳 彭玲 

机构地区：[1]重庆市开州区人民医院妇科,重庆405499

出　　处：《中国妇幼保健》2017年第15期3676-3679,共4页Maternal and Child Health Care of China

摘　　要：目的探讨阴道镜异常图像、阴道镜直视下活组织检查(活检)和宫颈环形电切术(LEEP)活检在宫颈上皮内瘤变(CIN)诊断中的价值。方法回顾性分析2014年3月-2016年9月该院收治并通过阴道镜拟诊、阴道镜直视下活检以及LEEP活检明确诊断的116例CIN患者的资料,行对照研究模式,统计分析上述几种检测方式在CIN诊断中的价值。结果阴道镜拟诊结果与阴道镜直视下活检诊断结果完全符合例数达到67例(57.76%),拟诊过度率22.41%(26/116),诊断不足率19.83%(23/116),两者诊断结果对比差异无统计学意义(χ~2=0.203 0,P>0.05);阴道镜拟诊结果与LEEP活检诊断结果完全符合例数达到70例(60.34%),拟诊过度率13.79%(16/116),诊断不足率25.86%(30/116),两者诊断结果对比差异无统计学意义(χ~2=0.398 4,P>0.05);阴道镜直视下活检结果与LEEP活检结果完全符合例数达到73例(62.93%),阴道镜直视下活检拟诊过度率12.07%(14/116),诊断不足率25.00%(29/116),两者诊断结果对比差异有统计学意义(χ~2=5.536 1,P=0.0186);将LEEP活检结果作为诊断金标准,统计发现通过阴道镜拟诊宫颈CINⅡ级与Ⅲ级的漏诊率相对较高,误诊率相对较低,在阴道镜拟诊宫颈CINⅠ级患者中,漏诊率与误诊率相对较低。结论宫颈CIN的早期诊断中,可将阴道镜作为辅助手段,但是单纯的阴道镜下活检在CIN的诊断准确率尚有不足,不可代替LEEP活检,推荐具有阴道镜CIN拟诊标准患者直接采取LEEP技术直接明确诊断。Objective To explore the value of abnormal colposcopic findings,colposcopic biopsy,and loop electrical excision procedure（ LEEP） biopsy in diagnosis of cervical intraepithelial neoplasia（ CIN）. Methods The data of 116 patients diagnosed as CIN definitely by colposcopy,colposcopic biopsy,and LEEP biopsy in the hospital from March 2014 to September 2016 was analyzed retrospectively,a case-control study was performed,the diagnostic value of the three methods for CIN was analyzed statistically. Results The coincidence rate of abnormal colposcopic findings and colposcopic biopsy was 57. 76%（ 67 cases）,the excessive rate of suspected diagnosis was 22. 41%（ 26/116）,and the underdiagnosis rate was 19. 83%（ 23/116）,there was no statistically significant difference in the diagnostic result between the two methods（ χ~2= 0. 203 0,P〈0. 05）. The coincidence rate of abnormal colposcopic findings and LEEP biopsy was 60. 34%（ 70cases）,the excessive rate of suspected diagnosis was 13. 79%（ 16/116）,and the underdiagnosis rate was 25. 86%（ 30/116）,there was no statistically significant difference in the diagnostic result between the two methods（ χ~2= 0. 398 4,P〈0. 05）. The coincidence rate of colposcopic biopsy and LEEP biopsy was 62. 93%（ 73 cases）,the excessive rate of suspected diagnosis was 12. 07%（ 14/116）,and the underdiagnosis rate was 25. 00%（ 29/116）,there was statistically significant difference in the diagnostic result between the two methods（ χ~2=5. 536 1,P = 0. 018 6）. Taking the result of LEEP biopsy as diagnostic gold standard,the missed diagnostic rates of abnormal colposcopic findings in diagnosis of CIN Ⅱ and CIN Ⅲ were high,while the misdiagnostic rates were low; the missed diagnostic rate and misdiagnostic rate of abnormal colposcopic findings in diagnosis of CINⅠ were low. Conclusion Colposcopy can be used as a supplementary means in early diagnosis of CIN,but the diagnostic accuracy of simple colposcopic biopsy in diagnosis of CIN is still ina

关 键 词：阴道镜 活体组织检查 宫颈环形电切术 宫颈上皮内瘤变 诊断价值 

分 类 号：R737.33[医药卫生—肿瘤]