阴道镜联合经阴道彩色多普勒超声诊断早期宫颈癌与癌前病变的临床价值

Clinical value of colposcopy combined with transvaginal color doppler sonography for diagnosis of early stage cervical cancer and precancerous lesions

目的了解阴道镜联合经阴道彩色多普勒超声(TVCDS)诊断早期宫颈癌与癌前病变的准确性及其临床应用价值,寻找筛查宫颈癌的有效方法。方法使用阴道镜联合TVCDS手段诊断189例早期宫颈癌与癌前病变,与病理检查结果作对比,分析比较阴道镜、TVCDS检查的诊断率,总结TVCDS声像图的特征。采用彩色多普勒血流显像技术进行宫颈部位血流分布的检测,测定并记录收缩期峰值的血流速度(PSV)与阻力指数(RI)。结果 TVCDS诊断率比阴道镜的诊断率低(均P<0.05);但TVCDS与阴道镜联合,可提高单用阴道镜的诊断率。阴道镜联合TVCDS检查对早期宫颈癌的诊断率为98.2%,对癌前病变的诊断率为100%。癌前病变的RI比早期宫颈癌低(P<0.05),癌前病变的PSV比早期宫颈癌高(P<0.05),因而宫颈癌的血流是低阻血流。结论阴道镜联合TVCDS诊断早期宫颈癌与癌前病变正确诊断率较高,是筛查宫颈癌的有效方法,对于宫颈病变的早期诊断具有较高的临床价值。

[Objective] To find out the accuracy and clinical application value of the diagnosis of colposcopy combined with transvaginal color doppler ultrasound （TVCDS） for early stage cervical cancer and precancerous lesions, and find an effective method of screening for cervical cancer. [Methods] Colposcopy combined with TVCDS diagnosis was used for 189 patients with early cervical cancer and precancerous lesions, the results were compared with the that of the pathological examination. The colposcopy and TVCDS diagnosis rates were comparatively analyzed, characteristics of TVCDS sonogram was summarized. Color Doppler flow imaging technology was used for the detection of the distribution of blood flow of cervical part, the peak systolic flow velocity （PSV） and resistance index （RI） were measured and recorded. [Results] Diagnosis rate of the TVCDS was lower than that of colposcopy （P 0.05）, but the colposcopy diagnosis rate of colposcopy were improved by combining with TVCDS. The diagnosis rate of colposcopy combined with TVCDS diagnosis for early cervical cancer was 98.2%, and the diagnosis rate for precancerous lesions was 100%. The RI of precancerous lesions was lower than earlier cervical cancer （P 0.05）, the PSV of precancerous lesions was higher than early cervical cancer （P 0.05）. Thus, the blood flow of cervical cancer was low resistance blood flow. [Conclusions] The colposcopy combined with TVCDS diagnosis for early stage cervical cancer and precancerous lesions has a high correct diagnosis rate, is an effective method of screening for cervical cancer, with a high clinical value for the early diagnosis of cervical lesions.