阴道镜下宫颈LEEP术联合术中冰冻病理用于CINIII诊治的临床研究  

Clinical research of loop electrosurgical excision procedure combined with frozen section examination during operation for the diagnosis and treatment of the cervical intraepithelial neoplasiaⅢ

作　　者：吴珍珍[1] 周丹[2] 王玥元[1] 白岩[1] 刘青[1] WU Zhenzhen;ZHOU Dan;WANG Yueyuan;BAI Yan;LIU Qing(Gansu Province Materal and Child Care Hospital, Lan Zhou, Gansu Province, 730050;Beijing Hospital)

机构地区：[1]甘肃省妇幼保健院,兰州730050 [2]北京医院

出　　处：《中国计划生育学杂志》2021年第7期1462-1466,共5页Chinese Journal of Family Planning

摘　　要：目的:评价阴道镜下宫颈LEEP术联合术中冰冻病理在宫颈上皮内瘤变Ⅲ级(CINⅢ)诊治方案制定中的价值。方法:回顾性分析2016年1-12月在本院妇科就诊,宫颈活检诊断为CINⅢ,接受阴道镜下宫颈LEEP术,同时行术中冰冻病理者共234例临床资料,比较术前宫颈活检、术中冰冻病检、术后石蜡病理检查的符合情况。结果:234例冰冻病理切缘判定的准确率98.29%(230/234),敏感度95.2%(80/84),阳性预测值100.0%(80/80),阴性预测值97.4%(150/154)。术后石蜡病理与术前、术中完全一致的154例,占65.8%(154/234);冰冻病理与石蜡病理一致202例,符合率86.3%(202/234),石蜡病理较冰冻病理升级但未超过术前病理16例,占6.8%(16/234);石蜡病理级别、分期上升者16例,占6.8%(16/234);其中2例术中即补充行宫旁广泛性切除+盆腔淋巴结清扫术,2例二次手术,占0.8%(2/234)。结论:阴道镜下宫颈LEEP术联合术中冰冻病理应用对于快速准确的诊断、指导治疗CINⅢ治疗具有可行性。Objective:To study the value of loop electrosurgical excision procedure(LEEP)combined with frozen section examination(FSE)during operation for diagnosis and treatment of cervical intraepithelial neoplasiaⅢ(CINⅢ).Methods:The clinical data of 234 patients with CINⅢafter biopsy result who had underwent LEEP and FSE were analyzed retrospectively.The coincidence situation of the results of preoperative biopsy,FSE during operation,and postoperative paraffin pathology examination were compared.Results:The accuracy,the sensitivity,the positive predictive value,and the negative predictive value of diagnosed by pathological margin of 234 unfreezing samples were 98.29%(230/234),95.2%(80/84),100%(80/80),and 97.4%(150/154),respectively.The pathology of paraffin samples of 154 cases(65.81%)after operation was completely consistent with that before and during operation.The pathology of paraffin samples of 202 cases was consistent with that of freezing samples,which concordant rate was 86.3%(202/234).There were 16 cases(6.8%,16/234)with the increased pathological stage diagnosed by the paraffin pathology,which was more than that by preoperative pathology,but was less than that by preoperative pathology.There were 16 cases(6.84%,16/234)with the increased grade of ICN and pathological stage diagnosed by the paraffin pathology,which included 2 cases had been supplemented with parauterine extensive excision combined with pelvic lymph node dissection and 2 cases(0.85%,2/234)had experienced secondary operation.Conclusion:Colposcopic LEEP combined with FSE during operation can diagnose and subsequent treat women with CINⅢrapidly and accurately,which is feasibility.

关 键 词：宫颈LEEP术 冰冻病理 宫颈上皮内瘤变Ⅲ级 

分 类 号：R737.33[医药卫生—肿瘤]