阴道镜指引下多点活检检测老年早期子宫颈癌的临床效果

发布时间：2018-03-08 14:35

  本文选题：宫颈上皮内瘤变　切入点：宫颈癌　出处：《中国老年学杂志》2017年12期 　论文类型：期刊论文

【摘要】：目的探讨阴道镜指引下多点活检检测早期子宫颈癌的临床效果。方法 412例人乳头瘤病毒(HPV)检测及宫颈细胞学检测异常的患者,行阴道镜指引下多点活检及子宫颈环形电切术(LEEP),回顾性分析患者LEEP手术前后病理变化,采用自身对照对比阴道镜指引下多点活检诊断结果和最终病理结果。结果阴道镜指引下多点活检诊断结果与LEEP手术后病理诊断结果相符者336例(86.94%),其中29例(7.04%)诊断不足,10例(2.43%)诊断过度。阴道镜指引下多点活检诊断慢性宫颈炎与病理结果一致性比较Kappa值为0.75,扁平湿疣/疣样病变诊断Kappa值0.65,子宫颈上皮内瘤变(CIN)Ⅰ诊断Kappa值0.78,CINⅡ/Ⅲ诊断Kappa值0.77,原位癌诊断Kappa值0.69,微小浸润癌诊断Kappa值0.75。本次研究样本中最终13例诊断为宫颈浸润癌,漏诊率为23.08%,对CINⅡ/Ⅲ级的漏诊率为7.65%,CINⅠ漏诊率7.50%,扁平湿疣/疣样病变漏诊率36.36%,慢性宫颈炎漏诊率9.95%。细胞学检查示高度鳞状上皮内病变(HSIL)及以上者阴道镜指引下多点活检的漏诊率23.61%,显著高于低度鳞状上皮内病变(LSIL)及以下者2.15%(χ~2=8.643,P0.05)。结论阴道镜指引下多点活检是早期诊断宫颈癌的有效方法,但其有可能漏诊高级别的宫颈癌及宫颈微小浸润癌。
[Abstract]:Objective to investigate the clinical effect of multipoint biopsy under colposcopy for early cervical cancer. Methods 412 patients with abnormal detection of HPV and cervical cytology were studied. Under the guidance of colposcopy, multipoint biopsy and circular electroresection of cervix were performed. The pathological changes of the patients before and after LEEP operation were analyzed retrospectively. The results of multipoint biopsy under colposcopy and final pathological results were compared by self-control. Results the diagnosis of multipoint biopsy under colposcopy was consistent with that of LEEP operation in 336 cases (29 of them were diagnosed by 7.04). Under the guidance of colposcopy, the consistency of pathological results with multipoint biopsy in the diagnosis of chronic cervicitis was 0.75, Kappa value of flat condyloma / verrucous lesion was 0.65, Kappa value of cervical intraepithelial neoplasia 鈪，

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