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目的对阴道镜下宫颈转化区类型和宫颈上皮内瘤变(CIN)诊断进行研究,探讨宫颈转化区类型对阴道镜下宫颈CIN诊断的影响。方法 2013年1月-2015年1月台州地区宫颈癌筛查异常行阴道镜检查并活检诊断为CIN者700例作为研究对象,该700例患者均行宫颈椎切术,切除标本送病理检查。观察700例宫颈病变患者阴道镜检查情况、组织病理学检查情况,不同转化区阴道镜检查结果和病理结果符合情况,不同转化区阴道镜下活检病理和LEEP病理结果符合情况。结果 700例患者阴道镜检查结果为:Ⅰ型转化区376例,Ⅱ型转化区203例,Ⅲ型转化区121例;正常和低度病变宫颈188例,高度病变宫颈512例;组织病理学结果显示:高度病变617例,正常和低级别病变35例,宫颈癌48例。Ⅰ型转化区阴道镜检查结果和组织病理学检查结果符合率为72.6%;Ⅱ型转化区阴道镜检查结果和组织病理学检查结果符合率为71.4%;Ⅲ型转化区阴道镜检查结果和组织病理学检查结果符合率为43.8%。Ⅰ型转化区和Ⅱ型转化区阴道镜检查结果和组织病理学检查结果的符合率比较没有差异(P>0.05),Ⅲ型转化区阴道镜检查结果和组织病理学检查结果的符合率低于Ⅰ型转化区和Ⅱ型转化区(P<0.05)。Ⅰ型转化区、Ⅱ型转化区和Ⅲ型转化区阴道镜活检和LEEP结果的符合率分别为73.4%、67.0%和55.2%,Ⅲ型转化区阴道镜活检和LEEP结果的符合率低于Ⅰ型转化区、Ⅱ型转化区(P<0.05),Ⅰ型转化区和Ⅱ型转化区阴道镜活检和LEEP结果的符合率比较,差异无统计学意义(P>0.05)。Ⅰ型转化区、Ⅱ型转化区和Ⅲ型转化区高度病变阴道镜活检和LEEP结果的符合率均高于正常或低度病变的符合率(P<0.05)。结论宫颈转化区类型影响阴道镜对CIN的诊断及阴道镜下活检的准确性。
Objective To study the type of cervical transformation zone and the diagnosis of cervical intraepithelial neoplasia (CIN) under colposcopy and investigate the effect of cervical transformation zone on the diagnosis of cervical CIN under colposcopy. Methods From January 2013 to January 2015, 700 cases of abnormal cervical cancer screening in Taizhou were examined by colposcopy and biopsy as CIN. The 700 patients underwent cervical vertebractomy and the specimens were removed for pathological examination. Colposcopy examination of 700 cases of cervical lesions, histopathological examination, colposcopy results of different transformation zones and pathological findings were consistent, colposcopy biopsy pathology in different transformation zones and LEEP pathological results in line with the situation. Results The results of colposcopy in 700 patients were 376 cases of type Ⅰ transformation, 203 cases of type Ⅱ transformation and 121 cases of type Ⅲ transformation, 188 cases of normal and low grade cervical lesions and 512 cases of high grade cervical lesions. The histopathological results Show: 617 cases of high grade lesions, 35 cases of normal and low-grade lesions, 48 cases of cervical cancer. The coincidence rate of type Ⅰ transformation zone colposcopy and histopathological examination was 72.6%. The coincidence rate of type Ⅱ transformation zone colposcopy and histopathological examination was 71.4%. The type Ⅲ transformation zone colposcopy results and tissue The coincidence rate of pathological examination was 43.8%. The coincidence rates of colposcopy type I and type II transformable colposcopy and histopathological examination showed no difference (P> 0.05). The coincidence rate of colposcopy type Ⅲ and histopathological examination in type Ⅲ transformation zone was lower than Ⅰ transformation zone and Ⅱ transformation zone (P <0.05). The coincidence rates of colposcopy biopsy and LEEP in type Ⅰ, Ⅱ and Ⅲ transformation zones were 73.4%, 67.0% and 55.2% respectively. The coincidence rates of colposcopy biopsy and LEEP in type Ⅲ transformation zone were lower than those in Ⅰ (P <0.05). There was no significant difference in coincidence rate of colposcopy biopsy and LEEP between type Ⅰ transformation zone and type Ⅱ transformation zone (P> 0.05). The coincidence rates of colposcopy biopsy and LEEP in type Ⅰ, type Ⅱ and type Ⅲ transformation areas were higher than those in normal or low grade lesions (P <0.05). Conclusion The type of cervical transformation zone affects the diagnosis of CIN by colposcopy and the accuracy of colposcopy biopsy.