阴道镜检查对宫颈病变的诊断价值

发布时间：2018-05-05 08:15

本文选题：宫颈癌 + 宫颈上皮内瘤变　；参考：《青岛大学》2017年硕士论文

【摘要】：背景:宫颈癌在世界范围内的发病率及死亡率均较高,且呈年轻化趋势,严重影响女性的身心健康。而宫颈癌是唯一有明确病因的恶性肿瘤,减少宫颈癌发病率及死亡率的重点在于宫颈癌尤其是宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的筛查。阴道镜检查是临床上筛查CIN和早期宫颈癌的重要步骤之一,且直接影响患者的诊疗方案,广泛地用于宫颈癌的筛查。而在现有报道中,阴道镜检查的诊断价值不尽一致。目的:探讨阴道镜检查的诊断价值,评估其在宫颈病变临床诊治中的作用。方法:回顾性分析2015-09至2016-10在青岛大学附属医院崂山院区就诊行阴道镜检查同时行宫颈活检,并根据阴道镜图像及活检病理结果最终行宫颈环形电切术(LEEP)、宫颈锥切术或全子宫切除术的536例患者的临床资料。采用自身对照,对这些患者的一般资料、阴道镜图像特征、宫颈活检病理及最终病理资料指标进行统计学分析。结果:本研究中536例患者的年龄分布为19~75岁,平均年龄32.9±3.4岁,平均孕2.8±0.4次,产1.7±0.3次。以患者宫颈活检病理及LEEP或宫颈锥切术或全子宫切除术后病理的最高病理诊断为最终病理诊断,并作为诊断标准。阴道镜图像诊断为高度鳞状上皮内病变(high-grade squamous intraepithelial lession,HSIL)及以上的病例共364例,低度鳞状上皮内病变(low-grade squamous intraepithelial lession,LSIL)及以下病例共172例。阴道镜图像拟诊断与最终病理诊断的总体符合率为72.20%(387/536),诊断不足的有111例(20.71%),诊断过度的有38例(7.09%)。阴道镜图像拟诊断为HSIL及以上、LSIL及以下的病例与最终病理诊断的总体符合率分别为89.56%(326/364)、35.47%(61/172),I型、II型、III型转化区患者阴道镜图像拟诊断与最终病理诊断的符合率分别为:78.73%、71.52%、57.27%(X~2(I,II)=2.84 P㧐0.05,X~2(II,III)=4.30 P㩳0.05,X~2(I,III)=18.01 P㩳0.05)。宫颈活检病理为低级别病变及以下的为139例,为高级别病变的共397例,宫颈活检病理与最终病理诊断的总体符合率为90.49%(485/536),诊断不足的有51例(9.51%),宫颈活检病理诊断为HSIL、LSIL及以下的病例与最终病理诊断的总体符合率分别为:96.98%(385/397)、71.94%(100/139),无宫颈活检病理为宫颈浸润癌的病例。I型、II型、III型转化区患者宫颈活检病理与最终病理诊断的符合率分别为:94.03%、91.14%、80.91%(X~2(I,II)=1.27 P㧐0.05,X~2(I,III)=15.20 P㩳0.05,X~2(II,III)=5.98 P㩳0.05)。结论:(1)阴道镜图像拟诊断、宫颈活检病理与最终病理诊断均有较高的符合率,阴道镜图像及阴道镜指导宫颈活检对宫颈病变均有较高的诊断价值,同时应提高对阴道镜图像诊断不足的认识。(2)宫颈转化区类型影响阴道镜检查诊断准确性,宫颈I型及II型转化区患者诊断符合率高于III型,而I型、II型之间诊断符合率无明显统计学差异。(3)阴道镜对宫颈高级别病变的诊断符合率高于低级别病变。
[Abstract]:Background: the incidence and mortality of cervical cancer in the world are higher and younger, which seriously affects the physical and mental health of women. Cervical cancer is the only malignant tumor with definite etiology. The focus of reducing the incidence and mortality of cervical cancer lies in the screening of cervical cancer, especially cervical intraepithelial neoplasms. Colposcopy is one of the important steps in clinical screening of CIN and early cervical cancer, which directly affects the diagnosis and treatment of patients and is widely used in cervical cancer screening. In current reports, the diagnostic value of colposcopy is not consistent. Objective: to evaluate the value of colposcopy in the diagnosis and treatment of cervical diseases. Methods: cervical biopsy was performed by colposcopy in Laoshan Hospital of Qingdao University from September to October 2016-2015-2016-10. The clinical data of 536 cases of cervical circumferential electroresection, cervix conization or hysterectomy were performed according to the colposcopy and biopsy results. The general data of these patients, the features of colposcopy, the pathological and final pathological data of cervical biopsy were analyzed statistically. Results: the age distribution of 536 patients in this study was 1975 years old, with an average age of 32.9 卤3.4 years, an average of 2.8 卤0.4 pregnancies and 1.7 卤0.3 births. The final pathological diagnosis was based on the highest pathological diagnosis of cervical biopsy and LEEP or cervical conization or total hysterectomy. A total of 364 patients with high-grade squamous intraepithelial lesions and above were diagnosed by colposcopy, and 172 patients with low-grade squamous intraepithelial lesions (LSILs) and below were diagnosed by colposcopy. The overall coincidence rate between colposcopy image diagnosis and final pathological diagnosis was 72.20 / 536%, 111 cases were underdiagnosed and 38 cases were over diagnosed. The overall coincidence rate of colposcopy with final pathological diagnosis was 89.56 / 326364 / 35.4761 / 172M / I / II conversion zone and final pathological diagnosis, respectively. The coincidence rates of colposcopy imaging and final pathological diagnosis were 78.7373 / 71.5222T / 77.277.277.277.272X ~ (2.84) ~ (2.84) P ~ (0.05) P ~ (0.05) P ~ (0.05) P ~ (0.05) P ~ (0.05) I ~ (2) and 18.01 ~ (0.05) P ~ (0.05) P ~ (0.05) respectively for colposcopic imaging and final pathological diagnosis of the patients with colposcopy and above LSIL (n = 8). The accuracy of colposcopy imaging was as follows:% 78.73% 71.522SIL ~ (2.84) P0. 084 P0. 084 P0. 0. 30 P0. 05 P0. 05. The pathology of cervical biopsy was 139 cases of low grade lesions and below, and 397 cases of high grade lesions. The overall coincidence rate between cervical biopsy pathology and final pathological diagnosis was 90.4995 / 536g, 51 cases (9.51g) were underdiagnosed. The overall coincidence rate of cervical biopsy pathological diagnosis of HSILLSIL and below with final pathological diagnosis was: 1% 96.98% 385% 3977.94% 100% 139m without cervical biopsy pathology. The coincidence rates of cervical biopsy pathology and final pathological diagnosis in patients with type I invasive carcinoma of type I type II or type III were 91.03 and 91.14, respectively. The diagnostic accuracy of cervical biopsy was 1.27 P1. 27 P0. 05 P0. 05 X2 IH2 and 15. 20 P0. 05 X2. III1 + 5. 98 P0. 05. Conclusion there is a high coincidence rate between cervical biopsy pathology and final pathological diagnosis in colposcopy image. The colposcopy image and colposcopy guiding cervical biopsy have high diagnostic value for cervical lesions. At the same time, we should improve the understanding of the insufficient diagnosis of colposcopy. 2) the type of transformation area of cervix affected the diagnostic accuracy of colposcopy. The diagnostic coincidence rate of patients with type I and type II conversion area was higher than that of type III. However, there was no significant difference in the diagnostic coincidence rate between type I and type II (P < 0.05). The diagnostic coincidence rate of high grade cervical lesions by colposcopy was higher than that of low grade lesions.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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