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目的:通过宫颈环形电切术(LEEP)对阴道镜活检诊断为轻度宫颈上皮内瘤样变(C INⅠ)进行重新评估,比较不同病理类型的高危型人乳头瘤病毒感染及TCT(液基细胞学检查)检测结果,评估阴道镜活检诊断C INⅠ的准确性和全面性。方法:选取2007年1月~2009年11月就诊于柳州市人民医院妇科的宫颈疾病患者,行TCT、HPV16及18 DNA及阴道镜检查,同时选取阴道镜下宫颈活检确诊为C INⅠ的患者90例,短期内行LEEP术,并采取自身对照法,对比阴道镜下活检和LEEP术病理结果。结果:阴道镜下活检与宫颈LEEP术后病理结果的符合率为81.11%(73/90),宫颈LEEP术后有49例降级为炎症,占54.44%(49/90),24例仍为C INⅠ,占26.67%(24/90),LEEP术后病理级别未升级的73例患者中,有16例HPV16、18阳性,占21.92%(16/73);宫颈LEEP术后病理升级的有17例,占18.89%(17/90),C INⅡ10例,C INⅢ7例(其中4例患者因年龄大,无生育要求,自愿要求行全子宫切除术,2例术后病检为C INⅡ,1例为C INⅠ,1例LEEP术后累及腺体最后诊断为中分化鳞癌),其中HPV16、18阳性13例(C INⅡ组中有6例,C INⅢ组中有7例),占76.47%(13/17)。高危型HPV(HR-HPV)阳性率及病毒负荷量在低级别宫颈病变及高级别宫颈病变中差异有统计学意义(P<0.01),并随着宫颈病变程度的加重而逐渐升高。TCT检测结果与LEEP术后病理结果存在相关性,TCT检测结果级别偏高,LEEP术后病理结果也趋向于偏高;两种方法的检测结果存在统计学差异(P=0.000),TCT检测结果级别偏低的,LEEP术后病检结果级别可能会偏高。结论:阴道镜直视下活检对确诊C INⅠ尚不够准确,存在着高级别病变漏诊的可能;阴道镜下活检诊断为C INⅠ而细胞学检查结果为HSIL或HR-HPV病毒负荷量较高时要警惕漏诊宫颈高级别病变的可能,LEEP术在明确诊断宫颈上皮内瘤样变中优于活检,是诊断和治疗C IN的一种有效地方法。
OBJECTIVE: To evaluate the diagnostic value of colposcopic biopsy for mild cervical intraepithelial neoplasia (CINⅠ) by cervical ring electrosurgical excision (LEEP). To compare the different pathological types of high-risk human papillomavirus infection and TCT Cytology) test results to assess colposcopy biopsy C IN Ⅰ accuracy and comprehensiveness. Methods: From January 2007 to November 2009, patients with cervical diseases who visited the gynecology department of Liuzhou People’s Hospital were selected for TCT, HPV16, 18 DNA and colposcopy. At the same time, patients undergoing colposcopic biopsy for CINⅠ Cases, short-term LEEP surgery, and to take their own control method, colposcopy biopsy and LEEP pathological results. Results: The colposcopy biopsy and pathological results of cervical LEEP were 81.11% (73/90), 49 cases of cervical LEEP were degraded to inflammation (54.44% (49/90), 24 cases were still C INI, accounting for 26.67% (24/90). Of the 73 patients who did not upgrade their pathological grade after LEEP, 16 were positive for HPV16,18 (21.92%, 16/73), and 17 Cases, accounting for 18.89% (17/90), CINⅡ10 cases, CINⅢ7 cases (of which 4 patients due to age, no childbirth requirements, volunteered for hysterectomy, 2 cases of postoperative examination as C IN Ⅱ, 1 Including CINⅠ, 1 case of LEEP, and finally diagnosed as moderately differentiated squamous cell carcinoma). Among them, 13 cases were positive for HPV16,18 (6 cases in CINⅡgroup and 7 cases in CINⅢ group), accounting for 76.47% (13/17). The positive rates of HR-HPV and viral load in low-grade cervical lesions and high-grade cervical lesions were significantly different (P <0.01), and gradually increased with the severity of cervical lesions. There was a correlation between the results of TCT and the pathological results of LEEP. The results of TCT showed that the level of TCT was high and the pathological results of LEEP also tended to be high. There was a significant difference between the two methods (P = 0.000) Low level, LEEP postoperative pathological results may be high level. Conclusion: Biopsy under colposcopy is not accurate enough to diagnose C IN, and there is a possibility of misdiagnosis of high-grade lesions. Colposcopy biopsy is C INⅠ and cytology results are high HSIL or HR-HPV viral loads To be alert to the possibility of misdiagnosis of high-grade cervical lesions, LEEP is more effective than biopsy in the diagnosis of cervical intraepithelial neoplasia. It is an effective method to diagnose and treat C IN.