陰道鏡下宮頸活檢和宮頸環形電切術后病理檢查對診斷宮頸病變的應用價值

黃定坤 宋林勇 陳濤 陳金蓉 唐艷

【摘要】目的：分析在陰道鏡下進行活檢及在宮頸環形電切手術后進行病理檢查對于宮頸病變的診斷意義。方法：選取在我院經人乳頭狀瘤病毒檢測及宮頸細胞學檢查發現異常，或在檢查無發現異常但經肉眼發現宮頸柱狀上皮出現中重度外翻的患者548例，對這些患者進行陰道鏡下宮頸活檢及宮頸環形電切術，對比宮頸環形電切術前后的病理診斷結果的改變。結果：陰道鏡下宮頸活檢診斷結果與LEEP術后病理檢查結果的符合率為49.27%；兩種診斷方法對CIN分期Ⅱ/Ⅲ級及原位癌診斷的一致性經Kappa分析，Kappa=0.63，一致性較高；陰道鏡下宮頸活檢與LEEP術后病理檢查總的準確診斷率分別為82.30%、68.43%，對診斷CINⅡ/Ⅲ級的準確診斷率分別為79.63%、81.48%，漏診斷率分別為20.37%、18.52%；陰道鏡下宮頸活檢與LEEP術后病理檢查對CINⅡ/Ⅲ級及原位癌的診斷與聯合診斷的一致性分析，K值分別是0.80、0.83。結論：陰道鏡下宮頸活檢及宮頸環形電切術后的病理檢查對診斷宮頸病變的診斷結果具有較高的一致性，兩種方法聯合診斷能顯著的提高診斷的準確性。

【關鍵詞】陰道鏡；宮頸活檢；宮頸環形電切術；宮頸病變

Application value of colposcope cervical biopsy and pathological examination in the diagnosis of cervical lesions after loop electrosurgical excision procedureHUANG Dingkun1， SONG Linyong1， CHEN Tao1， CHEN Jinrong1， TANG Yan2. 1.Department of Pathology， Dujiangyan Peoples Hospital， Dujiangyan 611830， Sichuan， China； 2.Department of Gynecology， Dujiangyan Peoples Hospital， Dujiangyan 611830， Sichuan， China

【Abstract】Objectives： To analyze application value of colposcope cervical biopsy and pathological examination in the diagnosis of cervical lesions after loop electrosurgical excision procedure. Methods： 548 patients who received human papilloma virus detection in our hospital with abnormal cervical cytology， or who had moderate-to-severe cervical columnar epithelium were selected. Colposcope cervical biopsy and loop electrosurgical excision procedure were performed. Pathological diagnosis results before and after the procedure was compared. Results： Coincidence rate of colposcopic cervical biopsy and pathological examination results after LEEP was 49.27%； kappa analysis was conducted on the consistency of two diagnostic methods on CIN stage II / III and carcinoma and Kappa=0.63， with high consistency； correct diagnosis rates of colposcopy cervical biopsy and LEEP postoperative pathology check were 82.30% and 68.43% respectively. In the diagnosis of CIN II / III， the accurate diagnosis rates were respectively 79.63% and 81.48%； missed diagnosis rates were respectively 20.37% and 18.52%； consistency analysis on colposcopic cervical biopsy and LEEP postoperative pathologic examination in diagnosis of CIN II / III and carcinoma showed that K value were 0.80 and 0.83 respectively. Conclusion： Colposcopic cervical biopsy and LEEP postoperative pathologic examination have high consistency in the diagnosis of cervical lesions， the combined diagnosis of which can significantly improve the diagnostic accuracy.

【Key words】Vaginal； Cervical biopsy； Cervical loop electro resection； Cervical lesions

【中圖分類號】R737.33【文獻標志碼】A

宮頸癌是一種在臨床上常見的婦科惡性腫瘤，具有較高的發生率和病死率，據近幾年的研究發現，宮頸癌在年輕女性中的發病率也在逐年升高[1，2]。盡早的檢測出癌前病變對防治宮頸癌至關重要。宮頸病變是除檢測出子宮頸上皮內瘤（cervical intraepithelial neoplasia，CIN）變外，還要檢測出宮頸浸潤癌，這樣才能做到早發現、早治療，改善預后[3，4]。……