即查即治策略处理宫颈高度鳞状上皮内病变的临床价值

Clinical value of see-and-treat strategy in the management of high-grade squamous intraepithelial lesion

目的:探讨即查即治策略处理宫颈细胞筛查为高度鳞状上皮内病变的安全性和有效性,为临床处理宫颈高度鳞状上皮内病变提供有价值的诊疗手段。方法:收集2009年1月至2011年10月年龄22～65岁、无妊娠、宫颈细胞学筛查为高度病变的妇女200例,按随机化的方法分为两组,一组按即查即治策略(A组)处理,另一组按传统三步法(B组)处理。比较两组的最终病理结果、术后3、6个月异常TCT(包括ASCUS)、切缘阳性或阴道镜异常等需行二次LEEP手术率。结果:A组的过度治疗率6%,CIN2、3检出率89%,原位癌检出率5%,二次手术率16%。与B组比较,过度治疗率、宫颈高度上皮内瘤变和宫颈癌的检出率、术后复查异常TCT、二次手术率均无明显差异(P>0.05)。结论:即查即治策略处理宫颈高度鳞状上皮内病变是安全、经济和有效的诊疗手段。

Objective To investigate the safety and efficacy of see-and-treat strategy in the management of high-grade squamous intraepithelial lesion （HSIL）, so that to provide a valuable diagnosis and treatment method for HSIL. Methods 200 non-pregnant women, aged 22 - 65 years, recruited as HSIL from January 2009 to October 2011 were randomized into 2 groups： see-and-treat strategy group （group A）, traditional method of three steps group （group B）. The final pathology result, TCT at 3 and 6 months after surgery （including ASCUS）, positive surgical margins, electronic colposcope image, and the rate that need to receive loop electrosurgica[ excision procedure （LEEP） the second time between the two groups were compared. Results The over-treatment rate in group A was 6%. The total detectable rate of HSIL was 89%, and that of carcinoma in situ was 5%. The rate of re- operation tbr positive surgical margins was 16%. There were no significant differences in the rates of over-treatment, of cervical intraepithelial neoplasia （CIN）, of cervical cancer, of re-operation, and abnormal cervical cytology after LEEP between the two groups （P 〉 0.05）. Conclusion See-and-treat strategy is a safe, effective and economical method for the diagnosis and management of HSIL .