阴道镜初学者前200个病例总结及学习曲线分析

摘要

目的 评估阴道镜初学者的检查效果,探讨阴道镜的学习曲线.方法 回顾性分析2015年3-10月在北京大学第一医院门诊由单一阴道镜初学者独立操作的最初200例患者.分前100例和后100例组,比较阴道镜检查指征、平均检查时间、活检率、宫颈病变检出率和阴道镜拟诊与病理诊断吻合率.结果 前100例和后100例组的平均年龄、阴道镜检查指征相比,差异无统计学意义(P＞0.05).前100例患者平均检查时间(14.87±3.83) min,后100例患者平均检查时间为(12.05±3.57) min,二者相比差异有统计学意义(P＜0.05).前100例患者中低度鳞状上皮内病变(LSIL)以上病变共33例,后100例患者中LSIL以上病变共27例,两者相比差异无统计学意义(P＞0.05).前100例组取活检的85例患者中,病理诊断与阴道镜拟诊完全一致者52例(61.2％),后100例组取活检的89例患者中,病理诊断与阴道镜拟诊完全一致者52例(58.4％),两者相比差异无统计学意义(P＞0.05).阴道镜检查后有4例患者分别因发热、出血和阴道填纱取出困难就诊,均发生在前100例组.结论 随着检查例数的增加,阴道镜初学者检查效率提高,宫颈病变检出率和拟诊吻合率基本稳定.%Objective To evaluate the effectiveness of colposcopy beginner and to define the learning curve of colposcopy examiner.Methods A retrospective study was performed.Totally 200 colposcopy cases at the outpatient clinic of Peking University First Hospital from March 2015 to October 2015 were included in this study.Patients were divided into two groups:the first 100 cases and the later 100 cases.The clinical characteristics,including age,indication of coloposcopy,examining time,rate of biopsy,the detection rate of cervical intraepithelial neoplasia (CIN) and the coincidence rate of eolposcopy with pathology,were compared.Results No significant difference was observed in the medium age and indication of colposcopy (P＞0.05).The medium examining time of first 100 cases was longer than that of the later 100 cases [(14.87±3.83) min vs.(12.05±3.57) min] (P＜0.05);Among the first 100 patients,33 turned out to be LSIL or worse,followed by 27 with LSIL or worse in the other 100 patients,no significant difference between the two groups was observed (33 vs.27 cases)(P＞0.05).No significant difference was observed in the coincidence rate with pathology (61.2％ vs.58.4％) (P＞0.05).Of the first 100 cases,four patients returned to out-patient clinic for the following reasons:fever,vaginal bleeding,and having difficulty removing the vaginal gauze.Conclusion The examining effectiveness increases with the cases accumulation for the colplscopy examining-beginner.The detection rate of CIN I or worse cases and coincidence rate with pathology are stable.