国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2013, Vol. 32 ›› Issue (3): 175-177.

• 论著 • 上一篇    下一篇

“即诊即治”法在宫颈上皮内瘤样病变诊疗中的价值

耿晓慧, 李鸿燕   

  1. 516000 广东省惠州市第一妇幼保健院（耿晓慧）；广东省佛山市顺德陈村医院（李鸿燕）
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2013-05-15 发布日期:2013-05-15

Value of ″See and Treat″ Method in the Diagnosis and Treatment of Cervical Intraepithelial Neoplasia

GENG Xiao-hui，LI Hong-yan   

  1. The First Maternal and Child Health Care Hospital of Huizhou City，Huizhou 516000，Guangdong Province，China（GENG Xiao-hui）；Chencun Hospital of Shunde District of Foshan City in Guangdong Province，Foshan 528300，Guangdong Province，China（LI Hong-yan）
  • Received:1900-01-01 Revised:1900-01-01 Published:2013-05-15 Online:2013-05-15

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摘要： 目的：探讨“即诊即治”法在宫颈上皮内瘤样病变（CIN）诊疗中的价值。方法：选取2009年5月—2011年12月经宫颈液基薄层细胞学（TCT）检查结果为CIN的已生育患者300例，根据TCT检查结果分为低度病变组（A组）和高度病变组（B组）。A组包括未明确诊断意义的不典型鳞状细胞（ASCUS）、未明确诊断意义的不典型腺上皮细胞（AGUS）、轻度鳞状上皮内瘤变（LSIL）的患者，共162例；B组为重度鳞状上皮内瘤变（HSIL）的患者，共138例。所有患者均行电子阴道镜量化评分系统（RCI）评分，A组采用阴道镜下宫颈组织活检并行宫颈电圈切除（LEEP）术，B组患者采用“即诊即治”法，即行LEEP术，对2组病理结果进行分析。结果：A组阴道镜下宫颈活检的CINⅡ以上检出率与LEEP术后的检出率比较差异无统计学意义（P＞0.05）。A组LEEP术后CINⅡ以上病理诊断率为18.52%（30/162），过度治疗率81.48%（132/162）。B组LEEP术后CINⅡ以上病理诊断率为80.43%（111/138），过度治疗率19.57%（27/138）；对B组患者，RCI评分诊断CINⅡ以上的敏感度为84.68%（94/111），特异度81.48%（22/27），阳性预测值94.94%（94/99），漏诊率15.31%（94/111），过度治疗率5.05%（5/99）。结论：对于TCT检查为宫颈高度病变、阴道镜RCI高评分的患者，采用“即诊即治”方法诊疗可减少过度治疗和漏诊。

关键词: 宫颈上皮内瘤样病变, 电外科手术, 阴道镜检查, “即诊即治”

Abstract: Objective：To evaluate the application of the "see and treat" approach of the loop electrosurgical excision procedure （LEEP） in women with cervical intraepithelial neoplasia（CIN）. Ｍｅｔｈｏｄｓ： Three hundred women having childbearing history with cervical intraepithelial neoplasia were included in this study. According to the test of cervical liquid-based cytology （TCT），cases were divided into two groups，group A（low lesions） and group B（high lesions）. Group A, included 162 cases with atypical squamous cells of undetermined significance（ASCUS）， atypical glandular cells of undetermined significance （AGUS）, low-grade squamous intraepithelial lesion （LSIL） patients. Group B included 138 cases with high-grade squamous intraepithelial neoplasia （ＨＳＩＬ）. All cases were scored by the electronic colposcope quantitative scoring system（RCI）. Cases of group A were treated by the cervical biopsy combined with colposcopy and electrosurgery（LEEP）. Cases of group B were treated by the "see and treat" approach of LEEP. Then pathological results were analyzed. Ｒｅｓｕｌｔｓ： There is not significant difference in the CIN Ⅱ detection rates between by cervical biopsy and by LEEP within group A（P＞0.05）. In group A, the pathologic diagnosis of CIN Ⅱ, or above, was 18.52%; while the over-treatment rate was 81.48%. In group B, the pathologic diagnosis of CIN Ⅱ or above was 80.43%, while the over-treatment rate was 19.57%. In group B, if combined with the RCI high score, the diagnosis sensitivity of CIN Ⅱ or above was 84.68%, specificity 81.48%, positive predictive value 94.94%，the omission diagnose rate 15.31%，and the over-treatment rate 5.05%. Ｃｏｎｃｌｕｓｉｏｎｓ： For those patients with HSIL by TCT and high scores by RCI，the "see and treat" approach can reduce the over-treatment rate and the omission diagnose rate.

Key words: Cervical intraepithelial neoplasia, Electrosurgery, Colposcopy, See and treat