现代肿瘤医学
現代腫瘤醫學
현대종류의학
Journal of Modern Oncology
2015年
20期
3009-3011
,共3页
电子阴道镜%宫颈上皮内瘤变%宫颈高频电刀环切术
電子陰道鏡%宮頸上皮內瘤變%宮頸高頻電刀環切術
전자음도경%궁경상피내류변%궁경고빈전도배절술
Colposcopy%cervical intraepithelial neoplasia%loop electrosurgical excision procedure
目的：探讨宫颈上皮内瘤变的早期诊断及合理治疗，以减少漏诊、过治及复发。方法：选取 LEEP 治疗的宫颈上皮内瘤变（CIN）患者136例，对此组患者术前阴道镜直视下活检结果与 LEEP 术后病理结果进行对比分析。结果：此组病例中，阴道镜下活检结果与 LEEP 活检病理学诊断结果的完全符合率为59．6％（81／136），诊断过度35例（25．7％），诊断不足20例（14．7％），两种方法的诊断结果差异有统计学意义（P ＝0．0403）。各个级别 CIN 阴道镜下活检结果与 LEEP 活检病理学诊断结果的完全符合率分别为43．5％（CINⅠ）、55．1％（CINⅡ）、80．0％（CINⅢ）。LEEP 治疗后切缘阳性患者14例，切缘阳性率为10．3％（14／136）。7例切缘阳性患者再次行全子宫切除术，术后4例患者子宫标本中有病灶残留，其病变残留率为57．1％。结论：阴道镜联合 LEEP 有助于 CIN 的早期发现、准确诊断及合理治疗，但存在病变残留可能，需重视术后随访。LEEP 治疗后切缘阳性是病灶残留的高危因素，对切缘阳性患者的处理有待于进一步探索。
目的：探討宮頸上皮內瘤變的早期診斷及閤理治療，以減少漏診、過治及複髮。方法：選取 LEEP 治療的宮頸上皮內瘤變（CIN）患者136例，對此組患者術前陰道鏡直視下活檢結果與 LEEP 術後病理結果進行對比分析。結果：此組病例中，陰道鏡下活檢結果與 LEEP 活檢病理學診斷結果的完全符閤率為59．6％（81／136），診斷過度35例（25．7％），診斷不足20例（14．7％），兩種方法的診斷結果差異有統計學意義（P ＝0．0403）。各箇級彆 CIN 陰道鏡下活檢結果與 LEEP 活檢病理學診斷結果的完全符閤率分彆為43．5％（CINⅠ）、55．1％（CINⅡ）、80．0％（CINⅢ）。LEEP 治療後切緣暘性患者14例，切緣暘性率為10．3％（14／136）。7例切緣暘性患者再次行全子宮切除術，術後4例患者子宮標本中有病竈殘留，其病變殘留率為57．1％。結論：陰道鏡聯閤 LEEP 有助于 CIN 的早期髮現、準確診斷及閤理治療，但存在病變殘留可能，需重視術後隨訪。LEEP 治療後切緣暘性是病竈殘留的高危因素，對切緣暘性患者的處理有待于進一步探索。
목적：탐토궁경상피내류변적조기진단급합리치료，이감소루진、과치급복발。방법：선취 LEEP 치료적궁경상피내류변（CIN）환자136례，대차조환자술전음도경직시하활검결과여 LEEP 술후병리결과진행대비분석。결과：차조병례중，음도경하활검결과여 LEEP 활검병이학진단결과적완전부합솔위59．6％（81／136），진단과도35례（25．7％），진단불족20례（14．7％），량충방법적진단결과차이유통계학의의（P ＝0．0403）。각개급별 CIN 음도경하활검결과여 LEEP 활검병이학진단결과적완전부합솔분별위43．5％（CINⅠ）、55．1％（CINⅡ）、80．0％（CINⅢ）。LEEP 치료후절연양성환자14례，절연양성솔위10．3％（14／136）。7례절연양성환자재차행전자궁절제술，술후4례환자자궁표본중유병조잔류，기병변잔류솔위57．1％。결론：음도경연합 LEEP 유조우 CIN 적조기발현、준학진단급합리치료，단존재병변잔류가능，수중시술후수방。LEEP 치료후절연양성시병조잔류적고위인소，대절연양성환자적처리유대우진일보탐색。
Objective:To discuss the early diagnosis and reasonable treatment of cervical intraepithelial neoplasia (CIN).Methods:All 136 cases of cervical intraepithelial neoplasia were selected,the colposcopically directed biopsy results were compared and analyzed with cervical loop electrosurgical excision procedure(LEEP)biopsy results.Re-sults:The consistence rate of the diagnosis by colposcopically directed biopsy and that by LEEP was 59.6%(81 /136),with the overdiagnosis rate 25.7%(35 /136)and the underdiagnosis rate 14.7%(20 /136).A significant difference between the diagnosis by colposcopically directed biopsy and that by LEEP was found (P =0.0403).The consistence rate of the diagnosis by colposcopically directed biopsy and that by LEEP in every grade of CIN were 43.5%(CINⅠ),55.1%(CINⅡ),80.0%(CINⅢ).14 patients were positive in their margins after LEEP,the posi-tive margin incidence was 10.3%(14 /136).7 cases with the positive margin underwent hysterectomy,among whom 4 had residual disease,its residual rate was 57.1%.Conclusion:Colposcopy had a certain rate of missed diagnosis,but LEEP can make up for the deficiencies of Colposcopy.If both joint application,it will be usefull to the early detection, accurate diagnosis and reasonable treatment of CIN.Postoperative follow -up played an important role in diagnosis and treatment because there was a certain residual rate.The positive margins after the treatment of LEEP is a high risk factor of residual lesions.The treatment to the patients who had positive margins still exist dispute and further re-search.
