宫颈病三阶梯式诊治法的探讨

Study of the three steps diagnosis and treatment on cervical lesions

目的探讨Thimprep液基细胞学(简称液基细胞学)检查在宫颈癌筛查中的应用价值,并探讨宫颈病三阶梯式诊治的临床意义。方法将宫颈病患者随机分为观察组和对照组。观察组2016例,用液基细胞学检查初筛;对照组1202例,用宫颈刮片巴氏染色法(简称巴氏法)初筛。随机抽取不典型鳞状上皮及以上病变者200例,其中100例为手术治疗组,进行阴道镜检+活检,环形电刀(LEEP刀)切除术治疗;另外100例为保守治疗组,进行物理治疗(微波,冷冻,激光等),必要时行宫颈锥切或子宫切除术。结果液基细胞学的低度鳞状上皮内瘤变(LSIL)以上病变检出率比巴氏法增加了82.42%,LSIL,高度鳞状上皮内瘤变(HSIL)的检出率分别增加了76.20%,112.12%。液基细胞学,巴氏法与病理诊断符合率分别为88.12%,58.25%。经液基细胞学检查—阴道镜检+活检—LEEP刀切除+病检三阶梯式诊治,LSIL的一次性治愈率为94.9%,HSIL为93.8%,总体治愈率94.5%;而巴氏法—物理治疗或手术治愈率85.2%。结论液基细胞学检查是显著提高宫颈病细胞学诊断的准确性。而宫颈病三阶梯式诊治法避免了不必要的宫颈锥切,减少了宫颈病的过度治疗,做到诊治规范化和个体化。

Object To evaluate the effect of ThinPrep cytologic test（TCT） in the scanning of cervical cancer, and the three steps diagnosis and treatment on cervical lesions. Method 2016 cases using TCT and 1202 cases using PAP were studied. 200 cases with atypical squamous cells of undetermined significance （ASCUS） and above were divided into two groups. One group, as the operation group, was performed electronic colposcopy and loop electrosurgical excisional procedure （LEEP）, which was defined as three steps diagnosis and treatment of cervical lesions. The other group, as the conventional treatment group, was undergone physical treatment, and cervical wimble excision or hysterectomy if necessarily. Result The check out rate of squamous intraepithelial lesion（SIL） through TCT was increased comparing PAP. The according rate between TCT and pathology diagnosis was higher than that of PAP. The heal rate of the operation group was higher than that of conventional treatment group. Conclusion TCT could raised the diagnosis accuracy on cervical lesions. The three steps diagnosis and treatment of cervical lesions＇could serve as the clinical routine of diagnosis and treatment of cervical lesions.