“即查即治”处理宫颈高度鳞状上皮内病变的临床价值

摘要

目的：探讨“即查即治”方法对宫颈细胞学为高度鳞状上皮内病变(high-grade squamous intraepithelial le-sion， HSIL)妇女的诊治价值，为临床提供有价值的诊疗手段。方法：收集2010年1月-2013年1月，年龄25～83岁，宫颈细胞学筛查为HSIL的妇女200例，按随机化的方法分为实验组(即查即治)和对照组(传统三阶梯诊断程序方法)。比较两组的宫颈电环切术后并发症发生率及最终病理结果。结果：实验组与对照组在宫颈电环切术后并发症发生率差异无统计学意义(P＞0.05)。实验组宫颈上皮内瘤样病变(cervical intraepithelial neoplasia，CIN)病理符合率98%(98/100)，对照组为97%(97/100)，以病理结果≤CIN 1作为过度治疗评判标准，实验组和对照组过度治疗率分别为9%(9/100)、11%(11/100)，两组病理结果及过度治疗率差异无统计学意义(P＞0.05)。结论：“即查即治”策略处理宫颈细胞学为HSIL是安全、经济和有效的诊疗手段。%Objective: To investigate the safety and efficacy of see-and-treat strategy in the management of high-grade squamous intraepithelial lesion(HSIL),so that to provide a valuable diagnosis and treatment method for HSIL. Methods: 200 non-pregnant women,aged 22-63 years old, recruited as HSIL from January 2010 to January 2013 were randomized into 2 groups:A see-and-treat strategy group,B traditional method of three steps group. The therapeutic efficacy and over-treatment rate of 2 groups were evaluated and compared. Results: There was no significant difference in postoperative complications in the LEEP and colposcopy score between two groups (P>0.05). Histological diagnosis of cervical intraepithelial neoplasia(CIN) was confirmed in 98%(98/100) patients in see & treat group and 97%(97/100) in control group (P>0.05). Using histological diagnosis≤CIN 1 as overtreatment, the overtreatment rate was 9%(9/100) and 11%(11/100) in “see-and-treat” group and control group respectively (P>0.05). Conclusion:See-and-treat strategy is a safe,effective and economical method for the diagnosis and management of HSIL.