宫颈上皮内瘤样病变“即诊即治”的新策略

The New Method of the Treatment of Cervical Intraepithelial Neoplasia the Study of the Suitable Group of the Adaptability of See and Treat Method

目的:探讨"即诊即治"在治疗宫颈上皮内瘤样病变治疗中的价值和发展前景。方法:选取2006年3月—2007年1月在上海交通大学医学院附属国际和平妇幼保健院宫颈细胞学异常患者169例。根据细胞学检查结果,将169例分为两组。A组:结果为未明确诊断意义的不典型鳞状细胞(ASCUS)、未明确诊断意义的不典型腺上皮细胞(AGUS)、低度鳞状上皮内病变(LSIL)的患者,共117例;B组:结果为高度鳞状上皮内病变(HSIL)的患者,共52例。并对两组结果进行回顾分析。结果:A组结合Reid阴道镜评分(RCI),LEEP治疗的特异性98.9%、阳性预测值87.5%、阴性预测值80.7%、总符合率81.2%,8例A组-RCI高评分患者中7例LEEP病理为CINII及以上。B组结合阴道镜RCI评分,LEEP治疗的特异性100.0%、阳性预测值100.0%、阴性预测值29.4%、总符合率76.9%,35例B组-RCI高评分患者中LEEP病理均为CINII及以上。结论:对于A组患者若阴道镜RCI高评分者,先行宫颈活检,根据病理结果,明确诊断后决定治疗方案。对于B组结合阴道镜RCI高评分患者可采用"即诊即治"方法治疗,而阴道镜RCI低评分的患者,在行阴道镜检查和宫颈活检明确诊断治疗后,需要密切随访复查。

Objective：To approach the adaptability of See and Treat method to identify a suitable group. Methods： A total of 169 subjects in compliance to the screening criteria, who were found the abnormal results of LCT. Group A contained 117 subjects with LCT results of ASCUS, AGUS and LSIL; Group B contained 52 subjects with the results of HSIL. The results of the two groups were analyzed retrospectively. Results： In group A with RCI score, the evaluation of LEEP is the specificity of 98.9%, the positive predictive value of 87.5%, the negative predictive value of 80.7%, the coincidence rate of 81.2 %. 87.5% in group A with RCI high score are CIN Ⅱ and above CIN Ⅱ. In group B with RCI score, the evaluation of LEEP is the specificity of 100.0%, the positive predictive value of 100.0%, the negative predictive value of 29.4%, the coincidence rate of 76.9 %. All in group B with RCI high score are CIN Ⅱand above CIN Ⅱ. Conclusion： Cervical biopsy should be taken firstly in patients in group A with RCI high score, and then the treatment should be depended on the pathology results. See and Treat method should be adapted to the patients in group B with RCI high score. Close follow-up should be performed to the patients in RCI low score after colposcope and cervical biopsy.