液基薄層細胞學、電子陰道鏡和宮頸環形電切術在宮頸上皮內瘤變中的臨床應用

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【摘要】 目的：探討液基薄層細胞學、電子陰道鏡和宮頸環形電切術在子宮頸上皮內瘤病變診斷治療中的臨床應用價值。方法：回顧性分析2011年本院收治的經液基薄層細胞學與電子陰道鏡宮頸病理活檢確診的106例宮頸上皮內瘤變患者的臨床資料，其中103例患者行宮頸環形電切術（LEEP），3例CIN-Ⅲ級于LEEP術后追加筋膜外子宮全切除術，術后標本行病理學檢查，比較分析TCT、陰道鏡活檢與LEEP術后病理結果的差異。結果：TCT與陰道鏡活檢結果符合率LSIL為81.25%，HSIL為89.66%。陰道鏡下活檢、病理與LEEP術后標本CIN-Ⅰ的符合率為59.18%，CIN-Ⅱ的符合率為79.31%，CIN-Ⅲ的符合率為82.14%，總體負荷率70.75%。結論：TCT與陰道鏡下病理活檢篩查上皮內瘤變主要方法、宮頸環形電切術是治療CIN的有效技術，同時具有一定的診斷價值，對于臨床減少宮頸上皮內瘤變漏診、誤診率有一定價值。

【關鍵詞】 宮頸上皮內瘤變； 液基薄層細胞學； 電子陰道鏡； 宮頸環形電切術

The Clinical Application of TCT，Colposcopy and LEEP in Cerical Intraepithelial Neoplasia/MEI Fang.//Medical Innovation of China，2014，11（28）：072-075

【Abstract】 Objective：To investigate the clinical value of TCT，colposcopic biopsies and LEEP in diagnosis and treatment of cervical intraepithelial neoplasia.Method：The clinical data of 106 patients with cerical intraepithelial neoplasia diagnosed with TCT and colposcopic biopsy in our hospital from January 2011 to December 2011 were retrospectively analyzed.All patients were treated with LEEP.Three cases of them with CIN-Ⅲ received extra fascial hysterectomy resection besides LEEP.The postoperative specimens were detected pathological examination.The difference and consistence rates of the results of TCT，colposcopic multiple biopsies and LEEP were compared.Result：The coincidence rate of TCT and colposcopy biopsy results was LSIL 81.25%，HSIL 89.66%，respectively.The overall consistence rate of pathology between colposcopic multiple biopsies and post-LEEP was 70.75%，and those of CIN-Ⅰ，CIN-Ⅱ and CIN-Ⅲ were 59.18%，79.31%，82.14%，respectively （P<0.05）.Conclusion：TCT and the colposcopic directed biopsy are the major monitoring way in cervical cancer and high-grade CIN.LEEP is an effective method of diagnosis and treatment of CIN and it could reduce the rate of misdiagnosis and missed diagnosis.

【Key words】 Cervical intraepithelial neoplasia； Thinprep cytological test； Electronic colposcopy； Loop electrosurgical excision procedure

First-authors address：Jiangsu Shengze Hospital of Wujiang District in Suzhou City，Wujiang 215228，China

doi：10.3969/j.issn.1674-4985.2014.28.026

宮頸癌是常見的婦科惡性腫瘤之一，嚴重危害廣大婦女的健康，宮頸上皮內瘤變（cervical intraepithelial neoplasia，CIN）是一組與宮頸癌密切相關的癌前疾病，從CIN發展為宮頸浸潤癌大約需要經過8～10年的時間，按照宮頸上皮細胞異型增生的程度及宮頸受累范圍，CIN分為CIN-Ⅰ、CIN-Ⅱ和CIN-Ⅲ級，其中高級別上皮內瘤變是CIN向浸潤性宮頸癌的關鍵階段。宮頸癌是目前婦科腫瘤里最能夠早期診斷、早期發現且有效治療的疾病，宮頸篩查和檢查治療在宮頸癌的三級預防具有重要的地位。本文選取2011年本院收治的經宮液基薄層細胞學檢查……