LEEP术在绝经后高级别CIN患者诊疗的价值评估

目的 探讨LEEP术在绝经后高级别CIN患者中的诊疗价值.方法 对2008年1月至2015年12月于浙江省衢州市妇幼保健院行子宫颈LEEP术的354例患者临床资料进行分析,以绝经后患者36例为实验组,同期1:3选择绝经前患者108例为对照组,分析临床症状、细胞学检查、HR-HPV检查、阴道镜检查及LEEP术后病理结果.结果 实验组阴道镜检查满意率显著低于对照组(χ2=17.779,P=0.000).以LEEP术后病理结果为诊断金标准,实验组LEEP术后病理级别升级者显著高于对照组(χ2=4.866,P=0.027),实验组阴道镜下活检病理的准确性显著低于对照组(χ2=3.992,P=0.046).实验组患者行LEEP术后病理结果提示切缘阳性率高于对照组,但两组间无显著性差异(χ2=3.416,P=0.065),其中实验组内切缘阳性率明显高于对照组,两组间差异有显著性意义(χ2=5.797,P=0.016);实验组外切缘阳性率高于对照组,但两组间无显著性差异(χ2=0.254,P=0.615).结论 绝经后女性仍建议定期行宫颈癌筛查,包括宫颈TCT及HR-HPV检测.绝经后患者的阴道镜检查满意率及准确性均下降;对阴道镜活检后诊为CIN的患者应行LEEP进一步确诊诊断.

Significance evaluation of LEEP for post menopausal women with high grade cervical intraepithelial neoplasia

Objective To evaluate the significance of LEEP in the diagnosis and treatment of high-grade cervical intraepithelial neoplasia (CIN) in post-menopausal women.Methods Clinical data of 354 patients undergoing LEEP in Quzhou Maternal and Child Health Hospital were analyzed, including 36 post-menopausal women in experimental group and 108 pre-menopausal patients in control group.Clinical manifestations, cytological examination, HR-HPV examination, colposcopy and pathological results after LEEP were analyzed.Results The satisfaction rate of colposcopy in the experimental group was significantly lower than in the control group (χ2 =17.779,P=0.000).The postoperative pathological results after LEEP were taken as gold standards for diagnosis.The pathological levels in the experimental group were significantly higher than those in the control group (χ2 =4.866,P =0.027).The accuracy of biopsy under colposcopy was significantly lower in the experimental group than in the control group (χ2 =3.992,P=0.046).After LEEP, the positive rate of the cutting edge in the experimental group was higher than in the control group, but no significant difference between two groups was found (χ2 =3.416, P=0.065).The positive rate of internal margin in the experimental group was higher, and there was significant difference between two groups (χ2 =5.797,P=0.016).The experimental group had higher positive rate of external margin than the control group, but no significant difference was indicated (χ2 =0.254,P=0.615).Conclusion Post-menopausal women are suggested to take cervical cancer screening regularly, including TCT and HR-HPV test.Both the satisfaction rate and accuracy of colposcopy decline for post-menopausal women.LEEP is needed for further confirm diagnosis among cases diagnosed with CIN after colposcopic biopsy.