阴道镜筛查宫颈病变1285例临床分析

A clinical analysis of 1258 cases of colposcopy for screening of cervical lesions

目的探讨电子阴道镜对宫颈病变的诊断价值。方法对2007年3月～2009年3月在中国西电集团医院妇产科经宫颈液基薄层细胞学检查结果为不典型鳞状上皮及以上分型和宫颈细胞学检查在巴氏Ⅱ级以上的1285例患者行电子阴道镜检查，同时对异常阴道镜图像的1009例患者采用电子阴道镜量化评分系统评估宫颈病变程度，并在阴道镜指引下行宫颈多点活检病理诊断，276例患者镜下未发现可疑病变部位，常规在转移带3、6、9、12点做活检，必要时辅助颈管搔刮。比较阴道镜与病理诊断结果。结果阴道镜量化评分诊断与病理诊断完全符合率为74．63％（959／1285），其中，诊断人乳头瘤病毒／宫颈上皮内瘤样病变Ⅰ完全符合率为68．38％（493／721）；诊断宫颈上皮内瘤样病变Ⅰ-Ⅱ完全符合率为64．47％（147／228）；诊断宫颈上皮内瘤样病变Ⅱ-Ⅲ完全符合率为83．72％（36／43）；诊断浸润癌完全符合率为94．12％（16／17）。结论电子阴道镜诊断宫颈病变较准确可靠，可预示子宫颈病变的严重程度，有很好的临床应用价值。

Objective To explore diagnostic value of electronic colposcopy for cervical lesions. Methods 1 285 women with atypical squamous cell （ASC） and above by cervical liquid-base thin layer cytologic examination （TCT） and grade Ⅱ and above of Pasteu classification by cervical cytological examination in Department of Gynecology and Obstetrics, Xi＇ an Xidian Group Hospital over a period from March, 2007 to March, 2009 received electronic colposcopy. Reid＇ s colposcopic index （RCI） scoring was used to evaluate degree of cervical lesions of 1 009 women with abnormal image, and multipoints biopsy of cervix was taken under colposcopy for pathological diagnosis. 276 women with normal image received routine cervical biopsy at 3, 6, 9, 12 points and cervical scraping smear if necessary. The results of electronic colposcopy and the results of pathological diagnosis were compared. Results Among 1 285 subjects, the complete diagnosis accordance rate between RCI scoring of electronic colposcopy and pathological examination was 74.63%, of which, the complete diagnosis accordance rate for HPV/CIN Ⅰ was 68.38%, that for CIN Ⅰ-Ⅱ was 64.47%, that for CIN Ⅱ-Ⅲ was 83.72% and that for invassive cervical carcinoma was 94.12%. Conclusion The electronic colposcopy is an acurate and reliable method for diagnosing cervical lesions, it can predict severity of cervical lesions. Therefore, it has good clinical application value.