三阶梯技术在436例宫颈病变中的应用价值探讨

The Application of Three-step Technology for Diagnosis and Treatment of 436 Patients with Cervical Lesions

目的:探讨三阶梯技术在宫颈病变诊治中的临床应用价值。方法:对2007年1月至2008年12月在中山大学附属肿瘤医院妇科宫颈病变门诊就诊的436例患者的临床病理资料进行回顾性分析。结果:细胞学诊断为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)、不典型鳞状上皮细胞不除外高度上皮内病变(ASC-H)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、鳞癌细胞(SCC)及不典型腺细胞(AGC),经活检病理确诊宫颈上皮内瘤变Ⅱ(CINⅡ)及以上病变的比例分别为30.7%、67.5%、43.3%、89.0%、100.0%、33.3%。ASCUS的病例中50.9%经活检病理诊断为慢性宫颈炎。阴道镜检查为正常、LSIL、HSIL、浸润癌与病理诊断的符合率分别为67.3%、31.4%、79.0%、75.9%。初次阴道镜检查可能低估了32.8%(62/189)的HSIL及42.0%(34/81)的浸润癌。阴道镜下多点活检与锥切术后病理结果符合者150例(76.5%),锥切术后确诊宫颈浸润癌39例。结论:对筛查结果有异常者进行阴道镜检查,可以有效地检出宫颈病变;宫颈锥切术是治疗宫颈上皮内瘤变及进一步排除浸润癌的重要手段。

Objective：To evaluate the utility of three-step technology for diagnosis and treatment of cervical lesions.Methods：The clinical data of 436 patients with cervical lesions who were managed in clinic of Sun Yat-sen University Cancer Center were analyzed retrospectively from January 2007 to December 2008.Results：The proportions of CINⅡ or worse lesion confirmed by biopsy from patients with ASCUS,ASC-H,LSIL,HSIL,SCC and AGC diagnosed by cytology were 30.8%,67.5%,43.3%,89.0%,100.0% and 33.3%,respectively.50.9% patients with ASCUS were finally confirmed as chronic cervicitis.The consis-tency of colposcopy with pathological diagnosis were 67.3% for normal,31.4% for LSIL,79.0% for HSIL and 75.9% for invasive carcinoma respectively.32.8%（62/189） HSIL and 42.0%（34/81） invasive cancer might be underestimated by the initial colposcopy examination.150 cases（76.5%） of colposcopic multiple biopsy had consistent pathologic results with cervical conization.39 cases were histologically proven cervical cancer after conization.Conclusions：The application of colposcopy could effectively find cervical lesions from patients with abnormal cytology.Conization is valuable in the treatment of CIN and diagnosis for early invasive cervical cancer.