液基薄层细胞学、电子阴道镜和宫颈环形电切术在宫颈上皮内瘤变中的临床应用

梅芳

【摘要】 目的：探讨液基薄层细胞学、电子阴道镜和宫颈环形电切术在子宫颈上皮内瘤病变诊断治疗中的临床应用价值。方法：回顾性分析2011年本院收治的经液基薄层细胞学与电子阴道镜宫颈病理活检确诊的106例宫颈上皮内瘤变患者的临床资料，其中103例患者行宫颈环形电切术（LEEP），3例CIN-Ⅲ级于LEEP术后追加筋膜外子宫全切除术，术后标本行病理学检查，比较分析TCT、阴道镜活检与LEEP术后病理结果的差异。结果：TCT与阴道镜活检结果符合率LSIL为81.25%，HSIL为89.66%。阴道镜下活检、病理与LEEP术后标本CIN-Ⅰ的符合率为59.18%，CIN-Ⅱ的符合率为79.31%，CIN-Ⅲ的符合率为82.14%，总体负荷率70.75%。结论：TCT与阴道镜下病理活检筛查上皮内瘤变主要方法、宫颈环形电切术是治疗CIN的有效技术，同时具有一定的诊断价值，对于临床减少宫颈上皮内瘤变漏诊、误诊率有一定价值。

【关键词】 宫颈上皮内瘤变； 液基薄层细胞学； 电子阴道镜； 宫颈环形电切术

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

宫颈癌是常见的妇科恶性肿瘤之一，严重危害广大妇女的健康，宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）是一组与宫颈癌密切相关的癌前疾病，从CIN发展为宫颈浸润癌大约需要经过8～10年的时间，按照宫颈上皮细胞异型增生的程度及宫颈受累范围，CIN分为CIN-Ⅰ、CIN-Ⅱ和CIN-Ⅲ级，其中高级别上皮内瘤变是CIN向浸润性宫颈癌的关键阶段。宫颈癌是目前妇科肿瘤里最能够早期诊断、早期发现且有效治疗的疾病，宫颈筛查和检查治疗在宫颈癌的三级预防具有重要的地位。本文选取2011年本院收治的经宫液基薄层细胞学检查……