三阶梯技术在436例宫颈病变中的应用价值探讨

摘要

Objective:To evaluate the utility of three-step technology for diagnosis and treatment of cervical lesions. Methods: The clinical data of 436 patients with cervical lesions who were managed in clinic of Sun Yat-sen University Cancer Center were analyzed retrospectively from January 2007 to December 2008. Results:The proportions of CIN TJ or worse lesion confirmed by biopsy from patients with ASCUS, ASC-H, LSIL, HSIL, SCC and AGC diagnosed by cytology were 30. 8%, 67. 5%, 43. 3%, 89. 0%, 100. 0% and 33. 3%, respectively. 50. 9% patients with ASCUS were finally confirmed as chronic cervicitis. The consis-tency of colposcopy with pathological diagnosis were 67. 3% for normal, 31. 4% for LSIL, 79. 0% for HSIL and 75. 9% for invasive carcinoma respectively. 32. 8% (62/189) HSIL and 42. 0%(34/81) invasive cancer might be underestimated by the initial colposcopy examination. 150 cases (76. 5%) of colposcopic multiple biopsy had consistent pathologic results with cervical conization. 39 cases were histologically proven cervical cancer after conization. Conclusions: The application of colposcopy could effectively find cervical lesions from patients with abnormal cytology. Conization is valuable in the treatment of CIN and diagnosis for early invasive cervical cancer.%目的:探讨三阶梯技术在宫颈病变诊治中的临床应用价值.方法:对2007年1月至2008年12月在中山大学附属肿瘤医院妇科宫颈病变门诊就诊的436例患者的临床病理资料进行回顾性分析.结果:细胞学诊断为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)、不典型鳞状上皮细胞不除外高度上皮内病变( ASC-H)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、鳞癌细胞(SCC)及不典型腺细胞(AGC),经活检病理确诊宫颈上皮内瘤变Ⅱ(CINⅡ)及以上病变的比例分别为30.7％、67.5％、43.3％、89.0％、100.0％、33.3％.ASCUS的病例中50.9％经活检病理诊断为慢性宫颈炎.阴道镜检查为正常、LSIL、HSIL、浸润癌与病理诊断的符合率分别为67.3％、31.4％、79.0％、75.9％.初次阴道镜检查可能低估了32.8％( 62/189)的HSIL及42.0％ (34/81)的浸润癌.阴道镜下多点活检与锥切术后病理结果符合者150例(76.5％),锥切术后确诊宫颈浸润癌39例.结论:对筛查结果有异常者进行阴道镜检查,可以有效地检出宫颈病变;宫颈锥切术是治疗宫颈上皮内瘤变及进一步排除浸润癌的重要手段.