宫颈锥切术对阴道镜检查不充分患者的诊治价值

Diagnosis and Treatment Value of Cervical Conization in Patients with Colposcopy Insufficiency

摘要: 目的：探讨宫颈锥形切除术对阴道镜检查不充分(TZ3型)患者的诊断价值并比较两种锥切方式对宫颈高级别病变的检出价值。方法：将2015年11月至2019年3月在青岛大学附属医院西海岸院区做过阴道镜且阴道镜评估不充分的104例患者作为研究对象。对比分析阴道镜联合宫颈管搔刮术(ECC)的活检与宫颈锥切术后的病理结果。同时，依据病人选择治疗方法的不同随机分为宫颈环形电切术组(n = 49)和冷刀锥切术组(n = 55)，对比分析两种锥切方式对宫颈高级别病变的检出价值。结果：宫颈锥切术后病理与阴道镜下活检联合ECC病理结果符合者54例(51.92%)，不符合的患者中检出高级别病变11例(10.58%)。宫颈环形电切术(LEEP)和宫颈冷刀锥切术(CKC)对宫颈高级别病变的检出率分别为8.16%和12.73%，两者差异无统计学意义。随诊的87例中，48例HPV转阴，转阴率为55.17%，平均转阴时间为8.9个月。结论：对于阴道镜评估不充分患者必要时应行诊断性宫颈锥形切除术，同时达到诊断和治疗的目的；在诊断性宫颈锥切除术中，LEEP术可以达到与CKC术同样的效果。

Abstract: Objective: To explore the diagnostic value of cervical conization in patients with colposcopy insufficiency (TZ3 type) and to compare the detection value of two conization methods for cervical high-grade lesions. Methords: From November 2015 to March 2019, 104 patients who had done colposcopy in the West Coast Hospital area of Qingdao University Affiliated Hospital and whose evaluation of colposcopy was inadequate were taken as the study objects. The pathological results of colposcopy combined with cervical curettage (ECC) and cervical conization were compared. At the same time, the patients were divided into two groups according to the different treatment methods that they elected: Loop electrosurgical excision procedure group (n = 49) and cold knife conization group (n = 55), comparative analysis of the detection value of two conization methods for cervical high-grade lesions. Results: 54 cases (51.92%) were in accordance with the pathological results of conization and colposcopy combined with ECC, 11 cases (10.58%) with high-grade lesions were detected in the patients who did not conform. The detection rates of Loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC) were 8.16% and 12.73%, respectively. There was no statistically significant difference between two groups. Of the 87 cases followed up, HPV of 48 cases turned negative, the rate of turning negative was 55.17%, and the average time of turning negative was 8.9 months. Conclusions: If necessary, diagnostic conization should be performed in patients with inadequate colposcopy, to achieve the purpose of diagnosis and treatment; in diagnostic cervical conization, LEEP can achieve the same effect as CKC.