阴道镜下活检对产妇宫颈病变的临床意义

The clinical significance of maternal colposcopy biopsy on cervical lesions

目的：分析宫颈液基薄层细胞学筛查（TCT）异常的孕妇，行阴道镜下活检诊断孕妇宫颈病变的临床意义和安全性。方法：采用队列研究方法，选择2012年10月至2014年1月在我院产科门诊初次检查的孕14—35周、1年内未进行过TCT的孕妇，先行TCT筛查，对TCT结果异常者，在知情并签字同意后进行阴道镜检查和阴道镜下宫颈活检。结果：TCT筛查的孕妇10857例，TCT结果异常978例，发生率为9．008％，TCT异常者中195例行阴道镜检查，镜下图像符合率93．0％（181／195），阴道镜拟诊宫颈上皮内瘤变（CINI）119例，CINⅡ24例，CINⅢ或宫颈鳞状细胞癌（SCC）52例。活检病理结果提示宫颈炎及CINI121例、CINⅡ28例、CINm33例、宫颈细胞癌（SCCI）13例。3例孕妇因宫颈局部压迫止血无效行创面缝合止血，未发生其他与阴道镜检查和宫颈活检相关的不良事件。结论：1年内未进行TCT筛查的孕妇进行TCT检查是必要的，对TCT结果异常者应进行阴道镜检查，阴道镜检查拟诊CINI及更高级别宫颈病变的孕妇，建议行宫颈活检以明确病理学诊断。

Objectives： To analyze the clinical significance and safety of colposcopy biopsy in diagnosis of the cervical lesions of pregnant women with abnormal thinprep cytology test （TCT） results. Methods： A cohort study was conducted on the pregnant women who were in their 14 - 35 weeks of pregnancy and had not received any TCT within a year when examined in our hospital from October 2012 to January 2014. For those with abnormal TCT results, colposcopy colposcopy and cervical biopsy were conducted after having signed an informed consent. Results： 10,857 pregnant women received TCT screening, 978 （9. 005% ） of who had abnormal results. Of the 978 pregnant women, 195 received routine colposcopy. The compliance rate of endoscopic image was 93.0% （ 181/ 195）, including 119 cases of colposcopy diagnosed cervical intraepithelial neoplasia （CIN）, 24 cases of CIN Ⅱ , and 52 cases of CINⅢ or cervical squamous cell carcinoma （SCC）. Biopsy results suggested that there were 32 ca- ses of cervicitis, 121 cases of CIN, 28 cases of CIN II , 33 cases of CIN Ⅱ and 13 cases of cervical carcinoma （SCC I ）. Except for three pregnant women who received suture hemostasis due to invalid cervical hemostasis by compression, there were no other adverse events associated with colposcopy and cervical biopsy. Conclusions： Pregnant women with abnormal TCT results should receive colposcopy, while cervical biopsy is necessary for those with suspected CINI or higher levels of cervical lesions, for clear oathological diagnosis.