“即诊即治”法及三阶梯法对宫颈病变的诊治价值

The Value of “See and Treat”Method and Three-step Method in the Diagnosis and Treatment of Cervical Lesions

目的探讨"即诊即治"法及三阶梯法对于宫颈病变的诊治价值。方法对2015年10月至2016年10月就诊于皖南医学院附属弋矶山医院妇产科门诊的159例TCT异常和/或HR-HPV阳性且阴道镜拟诊HSIL患者,93例采用三阶梯法,66例采用"即诊即治"法,比较两种方式的治疗效果。结果三阶梯组失访率9.7%,即诊即治组为0%。该84例(另有9例活检后失访)患者宫颈点活检及LEEP病理组织结果,诊断符合率59.5%(50/84),阴道镜下活检和LEEP两种方法的诊断结果差异有统计学意义(Kappa=0.341,P<0.01),两种诊断方法存在一致性,但一致程度并不高。三阶梯组过度治疗率9.5%,"即诊即治"组13.6%,两组差异无统计学意义(P>0.05);三阶梯组及"即诊即治"组两组RCI评分分别为(6.25±0.890)和(6.38±0.890),无统计学差异(P>0.05);两组就诊次数、就医花费比较(P<0.01),有统计学意义。结论 "即诊即治"法与三阶梯法对于细胞学检查联合HR-HPV检测并经阴道镜拟诊为HSIL的患者治疗效果相似,前者能明显减少就诊次数,缩短病变确诊及治疗的时间,减少患者精神焦虑及经济花费,减少失访率,节约医疗资源。

Objective To evaluate the value of ＂see and treat＂ method and three-step method in the diagnosis and treatment ofcervical lesions. Methods From October 2015 to October 2016, 159 cases with abnormal TCT and / or HR-HPV positive and col-poscopy diagnosed HSIL from gynecology and obstetrics department of the First Affiliated Yijishan Hospital of Wannan Medical Univer-sity were chosen. 93 cases were treated by three-step method, while 66 cases were treated by ＂see and treat＂ method. The therapeu-tic effects of the two groups were compared. Results The dropout rate of the three-step group was 9. 7%, while that of the ＂see andtreat＂ group was 0%. In the cervical biopsy and LEEP pathological results of the 84 cases （ with 9 missing cases after biopsy）, the di-agnostic accordance rate was 59.5% （ 50/84 ）. The diagnosis results of colposcopy biopsy and LEEP were statistically significant（ Kappa=0. 341, P〈0. 01 ）. These two diagnostic methods are consistent, but the degree of consistency was not high. The over-treat-ment rate of the three-step group was 9. 5%, while that of the ＂see and treat＂ group was 13.6%. The difference between the twogroups was not statistically significant （ P〉0. 05 ）. The RCI scores of the three-step group and the ＂see and treat＂ group were （6. 25＋0. 890） and （6. 38-＋0. 890） respectively. The difference was not statistically significant （P〉0. 05 ）. The frequency of clinical visitsand medical treatment cost of the two groups were statistically significant （ P〈0. 01 ）. Conclusion The therapeutic effects of ＂see andtreat＂ method and three-step method for HSIL patients diagnosed by cytolgical examination combined with HR-HPV detection and col-poscopy are similar. The former could significantly reduce the frequency of clinical visits, shorten the time of disease diagnosis andtreatment, reduce patients＇ anxiety and economic cost, reduce the dropout rate and save medical resources.