宫颈上皮内瘤变筛查方法在临床中应用研究.doc

宫颈上皮内瘤变筛查方法在临床中应用研究【摘 要】 目的:探讨宫颈上皮内瘤变筛查方法“细胞学―阴道镜检―组织学检查”，并对其在临床中的应用进行分析。 方法：将２００６年１～１２月在朝阳区第二医院妇科门诊接受液基薄层细胞学（TCT）检查的患者2349例，筛查出235例细胞学阳性病例。有201例患者接受阴道镜检查。镜检异常者，多点活检，病理诊断为确诊标准。对细胞学异常情况，宫颈视诊与宫颈细胞学的关系，细胞学阳性病例与病理诊断符合情况及4例宫颈癌患者的视诊与镜检特点进行分析。 结果：细胞学阳性率10%，细胞学HSIL的患者病理符合率50%，LSIL中15.4%CIN Ⅱ以上病例漏诊，ASCUS中CIN诊断率15.5%。结论：宫颈上皮内瘤变筛查方法应用于临床有助于提高CIN和癌的诊断。 【关键词】 细胞学―阴道镜检―组织学检查； CIN和癌 Clinical application of screening method for cervical intraepithelial neoplasia ZHANG Qinghua Department of Obstetrics and Gynecology, the Second Hospital of Chaoyang District, Beijing 100000, China 【Abstract】 Objectives: To study the screening method for cervical intraepithelial neoplasia and to analyze its clinical application. Methods: Among 2349 patients who accepted TCT test from January to December, 2006 in the Department of Obstetrics and Gynecology in the second hospital of Caoyang district, 235 cases were screened as cytologically positive. Then 201 cases were examined with vaginoscopy. Biopsy was applied to those who were tested as abnormal by vaginoscopy and the pathological diagnosis was the criteria for final decision. Analysis was made on the manifestation of cytological disorder, on the relationship between cervix appearance and its cytology, on the correspondence between cytological positive patients and their pathological diagnosis. Results: The rate of cytological positive cases is 10%. The correspondence rate between HSIL and pathological diagnosis is 50%. Above 15.4% of CIN II cases were misdiagnosed among LSIL. 15.5% patients were diagnosed as CIN among ASCUS. Conclusion: Screening method for cervical intraepithelial neoplasia could be applied in clinics to enhance diagnostic accuracy for CIN and neoplasia. 【Key words】 cytology-vaginoscopy-histological examination; CIN and neoplasia 子宫颈癌是危害妇女健康的一大杀手，病死率占女性生殖系统恶性肿瘤的第二位，仅次于乳腺癌。子宫颈癌的发病率近来呈现增高趋势，更有发病年轻化的趋势，预防、诊断和治疗更有其社会意义。现将我院妇科门诊2349例就诊患者采用“三阶梯”式诊断步骤，即“细胞学―阴道镜检―组织学检查”发现宫颈病变情况进行总结分析如下。 1 资料和方法 1.1 一般资料 统计2