液基细胞学、阴道镜下活检及LEEP术联合对宫颈上皮内瘤变诊治的临床价值

Clinical value of thinprep cytology test, colposcopic multiple biopsies and loop electrosurgical excision procedure in the diagnosis and treatment of cervical intraepithelial neoplasia

目的:探讨液基细胞学、阴道镜下活检与LEEP术在诊治宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)中的价值。方法:回顾性分析近3年来,在我院妇科门诊行LEEP手术的CIN患者560例,对比研究液基细胞学检查(thinprep cytology test,TCT)、阴道镜下活检及LEEP术后病理结果的差异及符合情况。结果:细胞学与阴道镜活检结果符合率LSIL 30.8%(45/146),HSIL 84.2%(133/158)。TCT检查HSIL病理符合率高于LSIL,差异具有统计学意义(P<0.05)。TCT检查结果为ASC-H活检病理CINII和CINⅢ的比率高于ASCUS患者,差异具有统计学意义(P<0.05)。阴道镜下活检病理与LEEP术后标本病理符合率:总符合率为57.9%,CINⅠ符合率为42.1%,CINⅡ为61.5%,CINⅢ为73.7%。CIN级别越高,符合率随之升高,其有统计学意义(P<0.05)。结论:LEEP术是一种能够准确诊断CIN病变的较好方法,其弥补了液基细胞学与阴道镜下活检的局限性和盲目性,三者联合使宫颈癌前病变的诊断和治疗更加完善,减少漏诊、误诊率。

Objective To evaluate the clinical value of thinprep cytology test （TCT）, colposcopic multiple biopsies and loop electrosurgical excision procedure （LEEP） in the diagnosis and treatment of cervical intraepithelial neoplasia （CIN）. Methods 560 patients with CIN, treated with LEEP in our gynecology outpatient department in the last 3 years were retrospectively analyzed TCT, colposcopic multiple biopsies and LEEP were compared The differences and consistence rates of the results of Results The consistence rates of LSIL and HISL by TCT and colposcopic multiple biopsies were 30.8% （45/146） and 84.2% （133/158）, respectively; that of HSIL by TCT and biopsy was signifieantly higher than that of LSIL （P 〈 0.05）. It was found that more patients diagnosed as ASC-H by TCT were diagnosed as CINⅡ and CINm by pathology than those diagnosed as ASCUS （P 〈 0.05）. The overall eonsistenee rate of pathology between colposeopie multiple biopsies and post-LEEP was 57.9%, and those of CIN I , CIN Ⅱ and CIN Ⅲ were 42.1%, 61.5%, 73.7%, respectively （P 〈 0.05）. Conclusion LEEP was an effeetive method for the diagnosis of CIN, which eould overcome the limitation and blindness of TCT and eolposeopic multiple biopsies. With the combined use of TCT, colposeopy and LEEP, the diagnosis and treatment of CIN could be improved, with less missed and delayed diagnosis.