阴道镜下宫颈活检联合宫颈环形电切术在宫颈病变诊治中的应用价值

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摘要目的探讨阴道镜下宫颈活检、宫颈环形电切术（LEEP）在宫颈病变诊治中的应用价值。方法回顾性分析2016年1月～2017年5月因宫颈液基细胞学筛查和/或HPV检测异常而于青岛大学附属医院行阴道镜下宫颈活检术，且自愿行宫颈LEEP术的159例患者的临床资料。观察阴道镜下宫颈组织活检、LEEP术后病理检查结果差异及诊断符合率。同时随访观察LEEP术在宫颈病变患者中的疗效。结果 159例患者中，阴道镜下宫颈活检及与宫颈LEEP术后病理检查均诊断为慢性宫颈炎、尖锐湿疣、宫颈上皮内瘤变（CIN）Ⅰ级、CINⅡ/Ⅲ级分别为2、4、60、59例，合计125例，4例患者经LEEP术后病理检查诊断为宫颈原位癌，诊断符合率为78.62%。4例慢性宫颈炎患者中，2例病理升级为CINⅠ；11例尖锐湿疣患者中，5例病理升级为CINⅠ，2例升级为CINⅡ/Ⅲ；76例CINⅠ患者中，11例病理升级为CINⅡ/Ⅲ，5例降为宫颈炎；68例CINⅡ/Ⅲ患者中，2例病理升级为宫颈原位癌，7例降为CINⅠ。阴道镜下宫颈活检与LEEP术后组织病理诊断宫颈病变的一致性为0.632，一致性较高。所有患者均顺利完成LEEP手术治疗，平均手术时间（27.50±5.03）min，平均术中出血量为（31.75±8.29）mL。除4例LEEP术后病理诊断为宫颈癌患者外，155例患者均实现定期随访，随访时间为12～28个月，术后6个月液基薄层细胞（TCT）检查结果提示155患者均无CIN，治愈率为97.48%，术后１年CINⅡ2例。结论阴道镜下宫颈活检、LEEP术后组织病理检查是诊断CIN及早期宫颈癌的有效方法，对宫颈病变的诊断一致性较高，LEEP术后组织病理检查可进一步降低高级别CIN及宫颈癌的漏诊率，值得临床应用。

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	刘鸣

关键词 ：宫颈病变, 阴道镜, 宫颈活检, 宫颈环形电切术

Abstract：Objective To explore the value of cervical biopsy combined loop electrosurgical excision procedure (LEEP) in the diagnosis and treatment of cervical lesions. Methods Clinical data of 159 patients diagnosed by cervical biopsy under colposcope because of abnormal cervical TCT and/or HPV detection and volunteered for cervical ring electrotomy (LEEP) in Affiliated Hospital of Qingdao University from January 2016 to May 2017 were retrospectively analyzed, the results of and pathological examination after LEEP operation and diagnose accordance rate were observed. Meanwhile, the efficacy of LEEP in patients with cervical lesions was observed. Results Among 159 patients, there were 2, 4, 60, 59 patients were diagnosed as chronic cervicitis, condyloma, cervical intraepithelial neoplasia (CIN) Ⅰ, CIN Ⅱ/CIN Ⅲ both by cervical biopsy under colposcope and pathological examination after LEEP surgery respectively, 4 patients were diagnosed as cervical carcinoma in situ by pathological examination after LEEP surgery, and the coincidence rate was 78.62%. Among 4 cases of chronic cervicitis, there were 2 cases were pathologically up to CIN Ⅰ; among 11 patients with condyloma, 5 patients were pathologically up to CIN Ⅰ, 2 cases pathologically up to the CIN Ⅱ/CIN Ⅲ; among 76 patients of CIN Ⅰ, 11 cases were pathologically up to CIN Ⅱ/CIN Ⅲ, 5 cases down to cervicitis; among 68 patients of CIN Ⅱ/CIN Ⅲ, 2 cases were pathologically up to cervical carcinoma in situ, 7 cases were pathologically down to CIN Ⅰ. The consistency in the diagnosis of cervical lesions between cervical biopsy and LEEP was 0.632, with a high consistency. All patients successfully completed LEEP surgery, with an average operative time (27.50±5.03) min and an average intraoperative blood loss (31.75±8.29) mL. Except for 4 cases of cervical cancer patients diagnosed by LEEP postoperative pathological, 155 patients were all implement regular follow-up, follow-up time was 12-28 months, TCT examination results 6 months after operation showed that 155 patients without CIN, the cure rate was 97.48%, 2 patients were diagnosed as CIN Ⅱ again 1 year after operation. Conclusion Cervical biopsy under colposcope and histopathological examination after LEEP surgery are effective methods for the diagnosis of CIN and early cervical cancer, with a high consistency of two methods. The LEEP surgery can further lower the missed diagnosis rate of the high grade of CIN and cervical cancer, which is worthy of clinical application.

Key words： Cervical lesions Colposcope Cervical biopsy Loop electrosurgical excision procedure

引用本文:

刘鸣. 阴道镜下宫颈活检联合宫颈环形电切术在宫颈病变诊治中的应用价值[J]. 中国医药导报, 2019, 16(8): 96-99.
LIU Ming. Application value of colposcope biopsy and with loop electrosurgical excision procedure in the diagnosis and treatment of cervical lesions. 中国医药导报, 2019, 16(8): 96-99.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I8/96

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