阴道镜下宫颈量化指标在宫颈高级别鳞状上皮内病变宫颈萎缩患者术式选择中的价值  

Value of Quantitative Cervical Index Under Colposcopy in the Surgical Selection of Postmenopausal Women With Cervical High-grade Squamous Intraepithelial Lesion

作　　者：徐海洋 王爽[1,3] 梁华茂[1] 游珂 张春妤[1] 张坤[1,4] 耿力[1] Xu Haiyang;Wang Shuang;Liang Huamao(Department of Obstetrics and Gynecology, Peking University Third Hospital,Beijing 100191, China)

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]大同市第三人民医院妇产科,大同03708 [3]北京市上地医院妇产科,北京100084 [4]北京大学第三医院病理科,北京1011

出　　处：《中国微创外科杂志》2020年第12期1073-1076,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨阴道镜下宫颈量化指标在绝经后宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)患者术式选择中的价值。方法对2012年1月~2019年4月我院收治的年龄≥50岁宫颈HSIL,因无法宫颈锥切而直接行筋膜外全子宫切除术的绝经后宫颈萎缩患者(全切组)以及行锥切后再行筋膜外全子宫切除患者(锥切组)进行1∶1配对,每组各41例。阴道镜下分别测量宫颈前后径D1和宫颈横径D2。根据D1和D2构建判别模型,研究判别模型的灵敏度、特异度及与手术分组符合率。另外选取35例锥切术进行验证。结果全切组D1、D2分别为(1.58±0.41)cm和(1.69±0.39)cm,锥切组分别为(2.10±0.31)cm和(1.90±0.39)cm,2组间D1和D2差异有统计学意义(P=0.000,P=0.015)。根据D1和D2构建的判别模型与手术分组相比,灵敏度和特异度分别为82.93%(95%CI:70.90%~94.95%)和75.61%(95%CI:61.89%~89.33%)。2组患者通过分类判别函数分类后术式符合率为79.27%(65/82),35例验证分类判别函数分类后术式符合率为82.86%(29/35)。结论阴道镜下宫颈径线测量可以更客观地反映患者宫颈情况,与主观判断选择手术方式有一定的一致性,可考虑作为术式选择的临床量化指标。Objective To determine the value of quantitative cervical index under colposcopy in the surgical selection of postmenopausal women with cervical high-grade squamous intraepithelial lesion(HSIL).Methods A retrospective analysis was made on HSIL patients aged≥50 years from January 2012 to April 2019.The postmenopausal patients with cervical atrophy who underwent extrafascial total hysterectomy due to inability of cervical conization(hysterectomy group)and patients who underwent extrafascial total hysterectomy after conization(conization group)were matched 1∶1 with 41 cases in each group.Colposcopy imaging technique was used to measure the anteroposterior cervical diameter(D1)and transverse diameter of the cervix(D2).A discriminant model based on cervical diameters was constructed.The sensitivity,specificity and the coincidence rate of the discriminant model based on cervical diameters were studied.Another 35 cases of conization were selected for verification.Results The D1 and D2 were(1.58±0.41)cm and(1.69±0.39)cm in the hysterectomy group,and(2.10±0.31)cm and(1.90±0.39)cm in the conization group.Significant differences could be seen between the two groups(P=0.001 and P=0.015).Compared with the original objective grouping,the sensitivity and specificity of the discriminant model of cervical diameters were 82.93%(95%CI:70.90%-94.95%)and 75.61%(95%CI:61.89%-89.33%).The coincidence of the two groups of patients was 79.27%(65/82)after classification by the classification function.The conformity rate of 35 patients for verification was 82.86%(29/35).Conclusion The measurement of cervical diameter under colposcopy can reflect the situation of patients’cervix more objectively,which is consistent with the subjective judgment and can be considered as a clinical quantitative index for the selection of surgical methods for HSIL patients with cervical atrophy.

关 键 词：高级别鳞状上皮内病变 绝经后 阴道镜 宫颈径线测量 筋膜外全子宫切除术 

分 类 号：R73[医药卫生—肿瘤]