CAJ | 학술논문

目的：探讨重度宫颈上皮内瘤变( CINⅢ)患者子宫切除术前行宫颈环切术( LEEP)的临床价值。方法：将70例阴道镜下活检确诊为CINⅢ患者先行LEEP后行全子宫切除术,对比阴道镜活检、LEEP后病理及切缘状态与全子宫手术标本病理情况的差异。结果：阴道镜活检、LEEP后宫颈组织病理学检查结果诊断不符合率28.57%,病理升级为浸润癌5例,升级率为7.14%；子宫切除术后病理提示慢性宫颈炎39例,无病变率55.71%；LEEP切缘阳性50例中,全子宫切除术后阳性23例,阳性率46.00%,LEEP切缘阴性20例中,全子宫切除术后阳性8例,阳性率40.00%；环切切缘阳性与阴性患者发生子宫残余病灶风险差异无统计学意义(P>0.05)。结论：阴道镜下多点活检对宫颈病变存在漏诊；需要全子宫切除的CINⅢ患者,术前一定要先行诊断性环切,直接切除子宫是有风险的。
목적：탐토중도궁경상피내류변( CINⅢ)환자자궁절제술전행궁경배절술( LEEP)적림상개치。방법：장70례음도경하활검학진위CINⅢ환자선행LEEP후행전자궁절제술,대비음도경활검、LEEP후병리급절연상태여전자궁수술표본병리정황적차이。결과：음도경활검、LEEP후궁경조직병이학검사결과진단불부합솔28.57%,병리승급위침윤암5례,승급솔위7.14%；자궁절제술후병리제시만성궁경염39례,무병변솔55.71%；LEEP절연양성50례중,전자궁절제술후양성23례,양성솔46.00%,LEEP절연음성20례중,전자궁절제술후양성8례,양성솔40.00%；배절절연양성여음성환자발생자궁잔여병조풍험차이무통계학의의(P>0.05)。결론：음도경하다점활검대궁경병변존재루진；수요전자궁절제적CINⅢ환자,술전일정요선행진단성배절,직접절제자궁시유풍험적。
Objective:To investigate the clinical value of loop electrosurgical excision procedure ( LEEP ) in patients with severe cervical intraepithelial neoplasia( CIN Ⅲ) before hysterectomy. Methods:Seventy patients with CIN Ⅲ diagnosed by colposcopy were treated with LEEP before hysterectomy. The pathological differences between colposcopy,LEEP edge tissue and total hysterectomy tissue were compared. Results:The disaccord rate of the pathological results between colposcopy and LEEP edge tissue was 28. 57%,and the pathology upgrading to infiltrating carcinoma in 5 cases were found,the upgrading rate of which was 7. 14%. Thirty-nine cases were diagnosed chronic cervicitis after hysterectomy,and the normal rate was 55. 71%. Among the 50 positive LEEP edge cases,23 cases were positive after hysterectomy,the positive rate of which was 46. 00%. Among the 20 negative LEEP edge cases 8 cases were posititve affter hysterectomy after hysterectomy, the positive rate of which was 40. 00%. The difference of the residual lesions risk of uterus between the positive and negative LEEP edge patients was not statistical significance(P>0. 05). Conclusions:The multi-point biopsy under colposcope has the possibility of missed diagnosis in cervical lesions. The diagnostic LEEP in CIN Ⅲ patients should be implemented before total hysterectomy,otherwise hysterectomy is risk.