影视阴道镜在子宫颈病变诊断中的应用

Video colposcopy in diagnosis of cervical squamous intraepithelial lesions

目的 评价影视阴道镜在子宫颈病变中的诊断价值及其临床意义。方法 应用影视阴道镜观察宫颈细胞病理学异常和尖锐湿疣患者共 2 75例。在阴道镜指引下行宫颈活检术 2 6 5例、宫颈管刮取术 (ECC) 8例、子宫颈环形电切术 (LEEP) 2 37例。结果 (1)影视阴道镜在诊断子宫颈病变中的敏感性为 95 9%、特异性为 77 7%、阳性预测值为 84 5 %。 (2 )影视阴道镜观察 ,93 8%正常转化区符合组织学诊断 ,有 6 1%的假阴性 ;76 2 %醋酸白上皮符合亚临床人乳头状瘤病毒 (HPV)感染的诊断 ,有 2 3 7%的假阳性。白嵌二联征、白嵌点三联征与宫颈癌的组织学诊断符合率为 10 0 0 %。结论 影视阴道镜诊断子宫颈病变的结果准确、可靠 ,有一定的临床应用价值 ,其诊断低度鳞状上皮内瘤变存在假阳性 。

Objective To study the accuracy and efficiency of video colposcopy in diagnosis of cervical squamous intraepithelial lesions and clinical significance of seven colpocopic signs. Methods Two handred and senventy five patients with an abnormal cervical smear or vulva condyloma acuminata were re evaluated by video colposcopy. 265 cervical biopsies performed under the guidance of video colposcopy for pathological study, as well 8 endocervical curettage (ECC) and 237 loop electrosurgical excision procedure (LEEP). Results The sensitivity, specificity and positive rate of video colposcopy in evaluation of cervical squamous intraepithelial lesions were 95 9%, 77 7%, and 84 5%. Video colposcopy diagnostic accuracy was 93 8% tally with the pathological results in observing normal transformation zone. False negative rate was 6 1%. 76 2% of cases with subclinical papillomavirus infection by acetowhite epitheliun, while false negative rate was 23 7%. Twin signs, triple signs and cervical carcinoma were 100 0% tallying with the diagnosis of cervical lesions. Conclusions Video colposcopy can be a very accurate diagnostic method in clinical practice. It is quite sensitive in diagnosis of severe cervical lesions. However, there was a relative high false negative rate in diagnosing mild cervical lesions.