阴道镜下宫颈管搔刮术对宫颈高级别病变检出的作用  

Role of ECC in detection of HSIL+ under comprehensive colposcopy and multi-site biopsy

作　　者：米兰[1] 颛佳 张岱[1] 毕蕙[1] MI Lan;ZHU AN Jia;ZHANG Dai;BI Hui(Department of Obstetrics and Gynecology, First Hospital of Peking University,100034)

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

出　　处：《中国妇产科临床杂志》2019年第2期128-131,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨阴道镜下子宫颈管搔刮术(ECC)在宫颈高级别病变(HSIL+)检出中的作用。方法回顾性分析2017年1月～2018年6月在北京大学第一医院妇产科阴道镜室进行全面阴道镜评估并同时进行多点定位活检(CDB)+ECC的744例患者的临床资料,以病理结果为诊断的金标准,评价ECC检出HSIL+的作用及影响因素。结果 ECC对于HSIL+的检出率为8.87%(66/744)。单因素分析发现:年龄(P=0.000)、细胞学异常(P=0.000)、HPV16/18阳性(P=0.003)、转化区可见性(P=0.001)、阴道镜印象(P=0.000)以及基于筛查及阴道镜印象的风险分层(P=0.000)对于ECC检出HSIL+有统计学差异;多因素回归分析发现,ECC对于HSIL+的检出与年龄(P=0.002)、细胞学异常(P=0.000)、HPV16/18阳性(P=0.002)、转化区可见性(P=0.019)以及阴道镜印象(P=0.000)相关。在风险分层中,低、中风险患者ECC对HSIL+检出率分别为2.94%、4.35%,其中4例活检病理为LSIL及以下,而ECC额外检出宫颈管的HSIL+。在高风险患者中ECC对HSIL+检出率为26.97%,并无额外检出。所有活检和ECC病理HSIL+者中,ECC下HSIL+的额外检出率为1.63%(4/245)。结论在全面阴道镜评估及多点活检下ECC额外检出作用有限,建议对阴道镜检查未见异常或异常程度低于筛查异常级别时,对转化区不完全可见的女性,尤其高龄女性行ECC,可额外增加HSIL+的检出。Objective To explore the role of ECC in the detection of HSIL+ under comprehensive colposcopy evaluation and colposcopy-directed punch biopsies.Methods The clinical data of 744 patients who underwent comprehensive colposcopy evaluation and colposcopy-directed punch biopsies(CDB)+ECC in the First Hospital of Peking University from January 2017 to June 2018 were retrospectively summarized.The role of diagnosis of HSIL+ ECC under colposcopy was evaluated based on the pathological results as the gold standard for diagnosis.Results The detection rate of ECC for HSIL+ was 8.87%(66/744).Univariate analysis showed that age(P=0.000),cytology abnormality(P=0.000),HPV16/18 positive(P=0.003),visibility of the transformation zone(P=0.001),colposcopy impression(P=0.000),and risk stratification based on screening and colposcopy impression(P=0.000) were statistically different for HSIL+ detection ECC.Multivariate regression analysis also found that HSIL+ detection of ECC was related to age(P=0.002),cytology abnormality(P=0.000),HPV16/18 positive(P=0.000),transformation zone(P=0.009),colposcopy impression(P=0.015).The detection rates of HSIL+ by ECC for low-risk and medium-risk patients were 2.94% and 4.35%,respectively.Among them,4 cases had biopsy pathology of LSIL and below,while ECC additionally detected HSIL+ in cervical canal.In high-risk patients,the detection rate of ECC for HSIL+ was 26.97%,and there was no additional detection.The extra detection rate of HSIL+ under ECC was 1.63%(4/245) in all biopsy and ECC pathology of HSIL+.Conclusion:The effect of ECC in detecting HSIL+is limited under comprehensive colposcopy evaluation and colposcopy-directed punch biopsies.It is suggested that ECC should be applied to those who are not completely visible in the transformation zone when colposcopy is not abnormal or the abnormal degree is lower than the screening abnormal level,which can additionally increase the detection of HSIL+ lesions.

关 键 词：阴道镜 多点定位活检 宫颈管搔刮术 宫颈上皮内病变 

分 类 号：R713.4[医药卫生—妇产科学]