阴道镜下宫颈活检和宫颈电环形切除术在宫颈上皮内瘤变诊断中的应用价值  

Application value of colposcopy cervical biopsy and cervical electric circular resection in the diagnosis of cervical intraepithelial neoplasia

作　　者：崔焱[1] 孟宪芹 孙莉[1] CUI Yan;MENG Xian-qin;SUN Li(Department of Gynecology,Beijing Hepingli Hospital,Beijing 100013,China)

机构地区：[1]北京市和平里医院妇科,北京100013 [2]大兴区妇幼保健院妇,北京102600

出　　处：《武警后勤学院学报（医学版）》2021年第12期56-57,60,共3页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】探讨阴道镜下宫颈活检和宫颈环形电切术(LEEP)在宫颈上皮内瘤变(CIN)诊断中的应用价值。【方法】选择在我院接受LEEP的细胞学可疑CIN患者261例作为研究对象,患者LEEP术前接受人乳头瘤病毒(HPV)高危DNA检测、细胞学检查、阴道镜引导活检,观察患者的高危HPV阳性率、术前细胞学与术后病理学的一致性、术前阴道镜引导活检与术后病理学一致性、LEEP术后并发症、复发率等。【结果】高危型HPV检测阳性213例;241例患者通过LEEP完全切除病变;12例患者术后出血加重和(或)术后疼痛。细胞学检查高级别鳞状细胞上皮内病变(HSIL)的92例患者中,最终89.13%(82/92)确诊为≥CINⅡ的病变[CINⅡ/Ⅲ或鳞状细胞癌(SCC)]。术后病理CINⅢ的患者中只有46.62%的患者显示HSIL结果。阴道镜活检和术后病理学检查符合率为86.59%(226/261)。术前阴道镜活检与术后病理学检查具有良好的一致性。CINⅡ/Ⅲ符合率高于慢性宫颈炎和CINⅠ符合率(P<0.05)。术后复发率为1.5%;6个月时有21.5%的患者检出高危型HPV阳性。【结论】阴道镜和靶向活检对宫颈高级别病变评估的准确性较高,LEEP手术是治疗宫颈高级别病变的有效方法,复发率低,HPV清除率高。【Objective】To investigate the value of colposcopic cervical biopsy and loop electrical resection procedure(LEEP)in the diagnosis of cervical intraepithelial neoplasia(CIN).【Methods】The 261 patients with cytological suspicious CIN who received LEEP in our hospital were selected as the research object.The patients received human papillomavirus(HPV)high-risk DNA detection,cytology and colposcopy guided biopsy before LEEP.The positive rate of high-risk HPV,the consistency between preoperative cytology and postoperative pathology,the consistency between preoperative colposcopy guided biopsy and postoperative pathology were observed postoperative complications and recurrence rate of LEEP.【Results】213 cases were positive for high-risk HPV;241 patients were completely resected by LEEP;Postoperative bleeding and/or postoperative pain were aggravated in 12 patients.Among 92 patients with high-grade squamous cell intraepithelial lesions(HSIL)by cytological examination,89.13%(82/92)were finally diagnosed as lesions≥CINⅡ[CINⅡ/Ⅲor squamous cell carcinoma(SCC)].Only 46.62%of the patients with postoperative pathological CINⅢshowed HSIL results.The coincidence rate between colposcopy biopsy and postoperative pathological examination was 86.59%(226/261).Preoperative colposcopy biopsy was consistent with postoperative pathological examination.The coincidence rate of CINⅡ/Ⅲwas higher than that of chronic cervicitis and CINⅠ(P<0.05).The recurrence rate was 1.5%;At 6 months,21.5%of patients were positive for high-risk HPV.【Conclusion】Colposcopy and targeted biopsy have high accuracy in the evaluation of high-grade cervical lesions.LEEP surgery is an effective method for the treatment of high-grade cervical lesions,with low recurrence rate and high HPV clearance rate.

关 键 词：宫颈上皮内瘤变 阴道镜 人乳头瘤病毒 环形电切术 

分 类 号：R711.32[医药卫生—妇产科学]