阴道镜直视检查在子宫颈上皮内瘤样病变切除手术中的临床意义

目的:本文研究了在子宫颈上皮内瘤样病变切除手术中应用阴道镜直视检查对患者治疗的临床意义。方法:对我院2009年2月至2010年7月期间进行切除治疗的254例子宫颈上皮内瘤样病变患者的临床资料进行了回顾性分析。结果:在子宫颈上皮内瘤样病变切除手术中应用阴道镜直视能够显著降低切除样本的平均高度和直径。患者平均随访时间为(29.2±3.1)月。39例患者最终确认为治疗无效。采用阴道镜直视切除手术的患者相对于手术中不采用阴道镜的患者,其治疗失败风险并无显著差异(HR:0.49;95%CI 0.21~2.33,P=0.468),而相对于阴道镜检查后立即进行切除手术的患者也无显著差异(HR:0.92;95%CI 0.57~1.68,P=0.846)。对治疗失败风险有显著影响的因素是清晰边界的确定(HR:0.35;95%CI 0.20~0.73,P=0.003)和手术切除直径(HR:2.56;95%CI 0.98~5.89,P=0.068)。结论:应用阴道镜直视于子宫颈上皮内瘤样病变切除手术中能够显著降低切除样本的尺寸,但不会导致治疗失败风险的显著变化。

Clinical significance of direct colposcopic vision during excision of cervical intraepithelial neoplasia

Objectives:To assess the clinical significance of using direct colposcopic vision (DCV) during excision therapy of cervical intraepithelial neoplasia (CIN).Methods:The clinical and pathological data of 254 endometrial carcinoma patients hospitalized from February 2011 to July 2015 were analyzed retrospectively.Results:DCV used in excision of CIN procedure resulted in a significant reduction in the mean height and diameter of the excised specimen.The median of patients' follow-up was (29.2 ± 3.1) months.39 patients were diagnosed with treatment failure.Compared to excisions performed without colposcopy,DCV was not found to have any significant impact on the risk of treatment failure (HR:0.49;95％ CI 0.21 ～2.33,P =0.468),neither when compared to excisions performed immediately after colposcopy (HR:0.92;95％ CI0.57 ～ 1.68,P =0.846).The factors found to have a significant impact on the risk of treatment failure were the identification of clear margins (HR:0.35;95％ CI 0.20 ～ 0.73,P =0.003) and the diameter of the surgical specimen (HR:2.56;95％ CI 0.98 ～ 5.89,P =0.068).Conclusion:The use of DCV during excision therapy of CIN is associated with a significant reduction in the dimensions of the excised cervical specimen,but does not result in a significant change in the risk of treatment failure.