不同方法对宫颈上皮内瘤样病变Ⅲ级和宫颈癌的诊断价值对比

Diagnostic Value of Different Methods for Cervical Intraepithelial Neoplasia Ⅲ and Cervical Cancer

目的观察阴道镜多点活检与宫颈冷刀锥切术在诊断宫颈上皮内瘤样病变(CIN)Ⅲ级以及早期宫颈癌中的诊断价值。方法经阴道镜活检病理诊断为CIN或早期宫颈癌的患者共112例,所有患者均于LEEP下行宫颈锥切术,术后将组织送检进行组织病理学检查,分析结果与阴道镜多点活检的差异。结果以宫颈冷刀锥切术为准,CINⅠ级患者23例,CINⅡ级患者38例,CINⅢ级患者34例,原位癌患者11例,浸润癌患者6例。对比阴道镜多点活检病理结果,发现结果相符合67例,不符合45例。其中,诊断不足有21例,诊断过度有24例。112例患者中,经诊断为宫颈浸润癌者11例,阴道镜多点活检漏诊率8.6%;宫颈冷刀锥切术的术中出血量、出血时间等指标显著低于阴道镜多点活检术,差异有统计学意义(P<0.05);宫颈冷刀锥切术出现术中出血、术后出血、术后子宫粘连等并发症发生率显著低于阴道镜多点活检法,差异有统计学意义(P<0.05)。结论阴道镜多点活检在诊断CIN特别是CINⅢ级时存在较大的局限性,而通过联合宫颈冷刀锥切能够提高早期宫颈癌患者诊断的准确率,从而有效避免了隐匿性宫颈癌的临床漏诊,可以作为对宫颈癌进一步诊断提供重要的参考依据。

Objective To observe the value of multiple point colposcopic biopsy and cervical cold knife conization in the diagnosis of cervical intraepithelial neoplasia n[ （CIN） and early cervical cancer. Methods 112 cases of CIN and early cervical cancer received menstrual colposcopic biopsy pathological diagnosis, all patients received cervical cone resection under LEEP, and tissues received histopathological examination after surgery, results and vaginoscopy muhipoint biopsy were compared. Results In cervical cold knife results,23 patients were Ⅰ grade CIN,38 patients were grade 11,34 patients were grade Ⅲ, 11 patients were carcinoma in situ,6 patients were invasive carcinoma. Compared with the pathological resuhs of biopsy,67 cases were in accordance, and 45 cases in discordance. Among them, there were 21 cases were underdiagnosis, and 24 cases were overdiagnosis. Among the 112 patients, 11 cases were diagnosed as cervical invasive carcinoma and the missed diagnosis rate was 8.6%. In cervical cold knife, bleeding volume and time were significantly lower than multiple point colposcopic biopsy, there had significant difference （P 〈 0.05 ） ; In cervical cold knife, intraoperative bleeding, postoperative hemorrhage, postoperative uterine adhesions were significantly lower than multiple point colposcopic biopsy, there had significant difference （P 〈 0.05 ）. Conclusion Multiple point colposcopic biopsy in the diagnosis of CIN, especially the m level has limit, cervical cold knife can increase the accuracy of diagnosis for early cervical cancer and avoid misdiagnosis, it can provide important reference for further diagnosis of cervical cancer.