摘要
目的:探讨重度宫颈上皮内瘤变(CINⅢ)患者子宫切除术前行宫颈环切术(LEEP)的临床价值。方法:将70例阴道镜下活检确诊为CINⅢ患者先行LEEP后行全子宫切除术,对比阴道镜活检、LEEP后病理及切缘状态与全子宫手术标本病理情况的差异。结果:阴道镜活检、LEEP后宫颈组织病理学检查结果诊断不符合率28.57%,病理升级为浸润癌5例,升级率为7.14%;子宫切除术后病理提示慢性宫颈炎39例,无病变率55.71%;LEEP切缘阳性50例中,全子宫切除术后阳性23例,阳性率46.00%,LEEP切缘阴性20例中,全子宫切除术后阳性8例,阳性率40.00%;环切切缘阳性与阴性患者发生子宫残余病灶风险差异无统计学意义(P>0.05)。结论:阴道镜下多点活检对宫颈病变存在漏诊;需要全子宫切除的CINⅢ患者,术前一定要先行诊断性环切,直接切除子宫是有风险的。
Objective：To investigate the clinical value of loop electrosurgical excision procedure （ LEEP ） in patients with severe cervical intraepithelial neoplasia（ CIN Ⅲ） before hysterectomy. Methods：Seventy patients with CIN Ⅲ diagnosed by colposcopy were treated with LEEP before hysterectomy. The pathological differences between colposcopy,LEEP edge tissue and total hysterectomy tissue were compared. Results：The disaccord rate of the pathological results between colposcopy and LEEP edge tissue was 28. 57%,and the pathology upgrading to infiltrating carcinoma in 5 cases were found,the upgrading rate of which was 7. 14%. Thirty-nine cases were diagnosed chronic cervicitis after hysterectomy,and the normal rate was 55. 71%. Among the 50 positive LEEP edge cases,23 cases were positive after hysterectomy,the positive rate of which was 46. 00%. Among the 20 negative LEEP edge cases 8 cases were posititve affter hysterectomy after hysterectomy, the positive rate of which was 40. 00%. The difference of the residual lesions risk of uterus between the positive and negative LEEP edge patients was not statistical significance（P〉0. 05）. Conclusions：The multi-point biopsy under colposcope has the possibility of missed diagnosis in cervical lesions. The diagnostic LEEP in CIN Ⅲ patients should be implemented before total hysterectomy,otherwise hysterectomy is risk.
出处
《蚌埠医学院学报》
CAS
2014年第9期1211-1213,共3页
Journal of Bengbu Medical College
关键词
宫颈上皮内瘤变
宫颈环切术
子宫全切术
severe cervical intraepithelial neoplasia
loopel ectrosurgical excision procedure
total hysterectomy
