即诊即治与三阶梯法治疗宫颈上皮内瘤样病变的临床探讨

＆quot;See and treat＆quot; versus three step strategy for cervical intraepithelial neoplasia

目的 观察即诊即治法（see and treat）与三阶梯法（即细胞学-阴道镜-组织学）治疗宫颈上皮内瘤样病变（CIN）的临床疗效,通过两组对比,评价两种治疗方法的优势与不足.方法 对2010年1月至2011年1月佛山市妇幼保健院和同济医院因宫颈病变行LEEP治疗的629例患者的细胞学、阴道镜、阴道镜引导宫颈活检（CDB）及宫颈电圈切除术（LEEP）组织病理学诊断结果进行回顾性分析.结果 三阶梯法（阴道镜引导宫颈活检）准确性较高,为84.57％,但存在着不足之处,即CDB诊断为低级别宫颈病变者,经LEEP治疗,术后病理证实有部分患者存在高度鳞状上皮内瘤变（HSIL）.选择HSIL患者采用即诊即治法行LEEP治疗,过度治疗率达16.43％.经TCT诊断为HSIL的患者联合阴道镜检查及Reid评分,在RCI高评分组中无过度治疗.结论 CDB可以发现大部分宫颈病变的患者,不足之处是不能排除宫颈浸润癌.即诊即治法应用于TCT联合阴道镜同时诊断为HSIL的治疗方法值得推广,可弥补CDB的不足,最大限度地提高宫颈病变诊断及治疗的及时性和准确性.

Objective To observe and compare the effiacies of ＆quot;see and treat＆quot; and three step strategy （cytology,colposcopy,and histology）for cervical intraepithelial neoplasia （CIN） and then to evaluate the advantages and disadvantages of the two methods.Methods The histopathological results of cytology,colposcopy,colposcopically directed biopsy（CDB）,and LEEP in 629 patients with CIN treated by LEEP at Tongji Hospital and Maternity and Children＆#39;s health Care Center of Foshan from January,2010 to January,2011 were retrospectively analyzed.Results The accuracy of CDB was 84.57%.CDB had some drawbacks that some patients be diagnosed with low grade CIN by CDB but with highly squamous intraepithelial neoplasia （HSIL） by postoperative pathology.Some patients with HSIL were chosen and treated by LEEP through ＆quot;see and treat＆quot; method,and 16.43% patients were over-treated.The patients with HSIL confirmed by TCT,coupled with colposcopy and Reid score,weren＆#39; t over-treated in high RCI score group.Conclusions Most CIN can be found out buting cervical invasive carcinoma can＆#39;t ruled out by CDB.＆quot;See and treat＆quot; for HSIL confirmed by TCT and colposcope is worth being clinically generalized,can make up for the inadequacy of CDB,maximumly improve the timeliness and diagnosis of CIN.