子宫颈四象限随机活检与阴道镜下定位活检HSIL+检出率比较  

A comparison of the positive detection rate of HSIL+ between four-quadrant random biopsies and colposcopy-directed biopsies

作　　者：颛佳 张岱[1] 贾芃[1] 毕蕙[1] Zhuan Jia;Zhang Dai;Jia Peng(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034;Department of Gynecology,Cangzhou People's Hospital,Cangzhou 061000)

机构地区：[1]北京大学第一医院妇产科,北京100034 [2]沧州市人民医院妇科,沧州061000

出　　处：《现代妇产科进展》2019年第2期101-104,108,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:通过分析宫颈定位活检及宫颈锥切标本病理HSIL+病变位点,理论上探讨随机点活检与定位活检在HSIL+检出率的差异。方法:回顾研究2016年1月至2018年6月在北京大学第一医院妇科因阴道镜下宫颈多点定位活检病理提示HSIL+,于阴道镜检查活检后1月内行宫颈锥切术的299例患者资料。综合宫颈点活检及宫颈锥切病理结果,对HSIL+病变累及部位、点数进行统计分析。结果:宫颈HSIL+病变最常见位点为6点和12点。根据病变所累及位点数将病例分为4组(1～3,4～6,7～9,10～12点)。细胞学低级别异常者173例(57.90%),细胞学高级别异常者126例(42.10%),不同的细胞学等级中不同组别所占比率存在统计学差异(P=0.00); HPV16/18阴性者130例(43.50%),阳性者169例(56.50%),两者中不同组别所占比率无统计学差异(P=0.06)。58例(19.40%)患者病变点位置未累及3/6/9/12点中任意一点,四组患者累及3/6/9/12点的比率存在统计学差异(P=0.00)。结论:阴道镜下四象限随机活检对于HSIL+的检出作用有限,尤其是在病变累及位点数≤3点者,建议阴道镜医生加强培训和实践,掌握阴道镜下定位活检技术,避免HSIL+的漏诊。Objective: To explore the difference of the detection rate of HSIL+ between random biopsies and colposcopy-directed biopsies theoretically by analyzing the HSIL+ lesion sites in cervical biopsy samples and conization samples histologically. Methods: We collected the clinical data of 299 patients who were diagnosed HSIL+ by colposcopy-directed biopsies and received cervical conization within 1 month after in the gynecology department of Peking University first Hospital between Jan.2016 and June 2018.Pathology results of colposcopy-directed biopsies and cervical conization were analyzed statistically,to determine the involved sites and numbers of HSIL+. Results: HSIL+ was most common on 6 and 12 o'clock direction of the cervix.We divided all the cases into four groups according to the number of the sites involved (1~3,4~6,7~9,10~12 points).173 cases (57.90%) were low-grade lesion in cervical cytology while the other 126 cases (42.10%) were high-grade lesion.There were significant differences of number of the HSIL+ sites between the low-grade and high-grade cytology groups ( P =0.00).130 cases (43.5%) were HPV 16/18-negative and 169 cases (56.5%) were HPV 16/18-positive.There were no significant differences in the number of the HSIL+ sites between them ( P =0.06).58 patients(19.4%) were not detected HSIL+ in any quadrant at 3/6/9/12 o'clock positions,and there were significant differences in the rate of HSIL+ detected in quadrants at 3/6/9/12 o'clock positions among the four groups( P =0.00). Conclusion: The value of four-quadrant random biopsies under colposcopy was limited to detect HSIL+,especially for those whose number of HSIL+ sites involved were less than or equal to 3 points.It is suggested that colposcopy operators should improve their skills for colposcopy-directed biopsies by more training and practice to reduce the rate of missed HSIL+.

关 键 词：阴道镜检查 随机活检 定位活检 子宫颈病变分布 

分 类 号：R711.74[医药卫生—妇产科学]