阴道镜下宫颈多点活检及宫颈管搔刮联合 LEEP术对 CIN诊治价值的分析

目的：探讨阴道镜下宫颈多点活检及宫颈管搔刮联合宫颈环形电切术（ LEEP）在宫颈上皮内瘤变（ CIN）中的临床诊断价值。方法选取2012年1月至2013年6月在杭州市江干区人民医院妇科行液基细胞学筛查（ TCT）检测异常的108例患者为研究对象，行阴道镜下多点活检及宫颈管搔刮，并对其中阴道镜下确诊为CIN及以上的68例患者行LEEP术的治疗及进一步诊断。结果 TCT诊断中异常的108例患者中，意义不明确的不典型鳞状细胞（ ASC-US）28例，不除外高度病变的不典型鳞状上皮细胞（ASC-H）22例，低度鳞状上皮内瘤变（LSIL）32例，高度鳞状上皮内瘤变（HSIL）20例，鳞状细胞癌（SCC）6例；与阴道镜活检诊断符合70例，符合率为64．81％。阴道镜下活检诊断，CINⅠ级16例，CINⅡ级12例，CINⅢ级10例，鳞状细胞癌6例，原位癌2例，浸润癌1例，颈管腺癌1例，与 LEEP 手术病理诊断符合60例，符合率为83．33％。 LEEP 术后治愈68例（100．00％），复发3例（4．41％），并发症发生率2例（2．94％）。结论阴道镜下活检及宫颈管搔刮准确率高于TCT准确率，阴道镜下多点活检及宫颈管搔刮联合LEEP术可提高CIN高级别诊断准确率，具有较高的临床应用价值。

Clinical analysis of colposcopic multiple biopsy and endocervical curettage combined with LEEP for treatment of CIN

Objective To investigate the clinical value of colposcopic multiple biopsy and endocervical curettage combining cervical loop electrosurgical excision procedure （LEEP） in diagnosis of cervical intraepithelial neoplasia （CIN）.Methods From January 2012 to June 2013 108 cases of women were detected with abnormal results by TCT in gynecology department of Jianggan District People ’ s Hospital of Hangzhou .Colposcopic multiple biopsy and endocervical curettage were performed to them , and 68 cases diagnosed with CIN or higher grade by colposcopy underwent LEEP for further diagnosis .Results Among 108 cases with abnormal results in TCT , there were 28 cases of ASC-US, 22 cases of ASC-H, 32 cases of LSIL, 20 cases of HSIL, and 6 cases of SCC.There were 70 cases in accordance with colposcopic biopsy （64.81%）.There were 16 cases of CIN grade Ⅰ, 12 cases of CIN Ⅱ, 10 cases of CIN Ⅲ, 6 cases of squamous cell carcinoma, 2 cases of cancer in situ, 1 case of infiltrating carcinoma and 1 case of adenocarcinoma of cervical canal diagnosed by colposcopy, among which 60 cases accorded with LEEP surgical pathology diagnosis and the coincidence rate was 83.33%.After LEEP surgery, 68 cases were cured （100.00%）, 3 cases relapsed （4.41%） and the incidence of complications was 2.94% （2 cases）. Conclusion Colposcopic biopsy and endocervical curettage is more accurate than TCT .Colposcopic multiple biopsy and endocervical curettage combined with LEEP can improve the diagnostic accuracy of high grade of CIN with high clinical value .