阴道镜在宫颈上皮内瘤变临床诊断中的应用价值分析

Application Value of Vaginal Endoscopy in Clinical Diagnosis of Cervical Intraepithelial Neoplasia

目的分析阴道镜检查及阴道镜下宫颈活检在宫颈上皮内瘤变（CIN）疾病诊断中的应用价值。方法收集2014年1月~2016年8月于我院进行治疗的367例CIN患者作为研究对象,以宫颈环形电切术（LEEP术）后组织病理作为确诊依据,比较阴道镜下宫颈活检病理与LEEP术后病理的符合率及CIN患者中不同类型宫颈转化区对阴道镜指导活检的影响。结果阴道镜指导下宫颈活检与LEEP术后组织病理诊断总体符合率为79.56%,其中,Ⅰ,Ⅱ型转化区活检诊断与LEEP术后组织病理诊断符合率91%;367例患者中诊断不足者50例（13.6%）,其中宫颈浸润癌27例（7.36%）;Ⅰ,Ⅱ型转化区活检准确率高于Ⅲ型转化区活检准确率,差异有统计学意义（P〈0.01）。结论阴道镜下宫颈活检对CIN的诊断准确性高,具有较高的临床应用价值,可作为基层地区CIN的筛查方法。不满意阴道镜下宫颈活检准确率低,易漏诊宫颈癌,建议综合考虑患者HPV感染类型、年龄及生育要求等决定是否直接行LEEP术诊治宫颈癌。

Objective To analyze the value of the application of cervical biopsy in the diagnosis of cervical intraepithelial neoplasia（ CIN）. Methods Collected from January 2014 to August 2016 in our hospital for treatment of367 cases of CIN patients as the research object,with LEEP surgery as the pathology after diagnosis compared with colposcopy cervical biopsy and LEEP postoperative pathological effects of different types of cervical transformation zone rate and CIN in patients with colposcopy biopsy guidance. Results The overall compliance rate of cervical biopsy and LEEP after biopsy under the guidance of vaginal cytology was 79. 56%,among them,satisfactory Colposcopy with biopsy diagnosis and pathological diagnosis with 263 /289 LEEP surgery（ 91% cases）; 50 cases of deficiency in the diagnosis of 367 cases of patients（ 13. 6%）,of which 27 cases of cervical cancer infiltration（ 7. 36%）; satisfaction cervical biopsy accuracy higher than satisfactory Colposcopy with biopsy accuracy rate,the difference was statistically significant（ P〈0. 01）.Conclusion Colposcopy with biopsy diagnostic accuracy of CIN is high,with a high clinical value,can be used as a screening method of CIN base area; not satisfied with the low accuracy of cervical biopsy,missed diagnosis of cervical cancer,suggest considering patients with HPV infection type,age and fertility requirements to decide whether directly LEEP in the diagnosis and treatment of cervical cancer.