宫颈锥切术对阴道镜检查临床应用的再评价

Revaluation of cervical conization to clinical application of colposcope

目的：探讨阴道镜检查的临床价值。方法：收集2005年6月～2007年6月经阴道镜检查并实施宫颈锥形切除的病例640例为研究对象，其中宫颈上皮内瘤变（CIN）147例，冷刀锥切（CKC）17例，宫颈环形电切（LEEP）130例；宫颈炎493例，全部LEEP手术，所有标本病理检查。比较锥切前后病理诊断及相关因素。结果：以宫颈锥切诊断为准，则阴道镜检查诊断宫颈疾病符合率（准确率）为88．0％（562／640），其中宫颈炎为97．4％，CIN为55．8％；而宫颈CIN分级诊断符合率（准确性）较低，仅为38．1％（56／147）。以锥切前后复核病理诊断为准，则阴道镜检查诊断宫颈疾病的准确性为97．5％，诊断宫颈癌及其CIN的准确性为91．9％、特异性97．4％、敏感性100％；细胞学HISL、阴道镜HISL、CINIR、弥漫型病灶、病灶累腺、病灶p16^INK4A阳性是病变升级的高危因素；CKC术后病变升级明显高于LEEP。结论：阴道镜检查多点活检早期诊断宫颈癌及CIN具有极高的准确性和特异性，是宫颈癌三阶梯筛查的关键步骤，并有指导和监视治疗的作用。对早期发现、早期诊断、早期治疗宫颈癌及CIN具有重要价值，宜在临床广泛推广应用。但也存在一定的局限性。

Objective： To study the clinical importance of colposcope. Methods： A total of 640 cases of cervical conization after eolposeope were collected from June, 2005 to June, 2007. Among them, there were 147 eases of cervical intraepithelial neoplasia （CIN） who were performed cold knife conization （CKC） （n = 17） or loop electrical excision procedure （LEEP） （n = 130） ; and 493 eases of eervities who were performed LEEP. All samples were performed pathological examination. A comparison analysis on pathological diagnosis of before and after conization and correlation factors was conducted. Results： According to diagnosis on cervical eonization, the diagnostic coin- eidenee rate （accuracy rate） of eolposeope on cervical disease was 88% （562/640）, including eervities 97. 4%, CIN 55.8%; while the coincidence rate （ accuracy rate） on CIN classification was low, only 38.1% （56/147） . According to checked pathological diagnosis on before and after conization, the coincidence rates of eolposeope on cervical disease and cervical cancer （including CIN） were 97.5% and 91.9%. Specificity and sensitivity on cervical cancer （including CIN） were 97. 4% and 100%. The high -risking factors to focus depravation included cytology HISL, eolposeope HISL, CIN Ⅲ, diffusing focus, focus implicating glands and pl6INK4A （ ＋ ） focus. The upgrading rate after CKC was obviously higher than that after LEEP. Conclusion： Colposeope including multi - biopsy has high accuracy and specificity in early diagnosis on cervical cancer and CIN. It is committed step to cervical cancer screening and can supervise clinical treatment. There is great importance for eolposeope on early discovery, diagnosis and treatment on cervical cancer and CIN, which should be extended. However, it has some limitations which cannot be neglected.