阴道镜下活检与宫颈锥切术后病检诊断宫颈上皮内瘤样病变

Colposcopically directed biopsy and cone biopsy diagnose cervical intraepthelial neoplasia

目的:比较阴道镜下活检与宫颈锥切术后病检诊断宫颈上皮内瘤样病变的价值。方法:我院门诊共82例患者,阴道镜下多点活检病理诊断为宫颈上皮内瘤样病变Ⅰ级13例,Ⅱ级36例,Ⅲ级33例(其中C IS 4例)收入住院行宫颈锥切术。采用冷刀与电刀结合的方法切除宫颈常规送病检。结果:锥切术后病理结果显示慢性宫颈炎10例,宫颈上皮内瘤样病变Ⅰ级10例,Ⅱ级28例,Ⅲ级31例(C IS 6例)。侵润癌3例。阴道镜下活检结果为宫颈上皮内瘤样病变Ⅲ级与宫颈锥切术后常规病检结果符合率(81.82%)高于宫颈上皮内瘤样病变Ⅰ级(61.54%)和Ⅱ级(66.67%),但差别无统计学显著性意义(P>0.05)。结论:研究显示阴道镜下活检诊断宫颈上皮内瘤样病变Ⅲ级的准确性有较Ⅰ级和Ⅱ级高的趋势。宫颈锥切术可以部分弥补阴道镜下活检的缺陷,且有治疗作用。

Objective To compare the dia biopsy after conization for cervical intraepthe cervical intraepthelial neoplasia （13 colposcopy undergoing cold-knife with CIN gnostic value betwe lial neoplasia. Meth Ⅰ and 36 CIN Ⅱ , 33 en biopsy directed Colposcopy and ods Eighty-two patients diagnosed CIN Ⅲ ） were done biopsy directed conizations combined electrosurgical excision procedure. The conventional pathologic diagnosis was recorded in all conization specimens. Results Biopsy after conization indicated 10 patients with chronic cervicitis, 10 patients with CIN Ⅰ , 28 patients with CIN Ⅰ and 31 patients with CIN Ⅲ （comprised 6 patients with carcinoma in situ）. There were 3 patients with invasive carcinoma. The coincidence rate between biopsy directed colposcopy and cone biopsy in CIN Ⅲ group （81.82%）was significantly higher than CIN Ⅰ group （61. 54%） and CIN Ⅱ group （66. 67%） ,but there were no statistical significant difference. Conclusion The accuracy of biopsy directed Colposcopy for diagnosing CIN Ⅲ is higher than that for CIN Ⅰand CIN Ⅱ. Cone biopsy can compensate partially the deficiency of biopsy directed Colposcopy, and can play a therapeutic role.