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[摘要] 目的 探讨阴道镜图像在宫颈上皮内瘤变中的诊断价值。 方法 选取2014年5月～2015年5月在我院进行健康查体两癌筛查的妇女3000名，均进行宫颈TCT筛查，其中筛查出宫颈ASC-US患者60例，宫颈LSIL 30例，HSIL 10例，非典型腺细胞20例，共40例具有阴道镜检查指征患者，其中20例行HPV检查，筛查出高危性HPV患者10例，低危性HPV患者2例，其余8例HPV阴性。所有患者均行阴道镜醋酸染色 碘染色，根据图像变化行多点活检，必要时加ECC，待术后病理结果。通过观察阴道镜下宫颈图像的变化以及阴道镜下宫颈活检术后病理结果，分析阴道镜在宫颈上皮内瘤变诊断中的作用。 结果 宫颈细胞学ASC-US患者阴道镜活检病理中慢性宫颈炎检出率达66.6%，宫颈低级别上皮内瘤变CINⅠ占26.7%，宫颈高级别上皮内瘤变CINⅡ～Ⅲ占6.7%；宫颈细胞学LSIL患者中阴道镜下活检病理以CINⅠ占56.7%，慢性宫颈炎占23.3%，CINⅡ～Ⅲ占20%，宫颈细胞学为ASC-H，HSIL时阴道镜下活检病理CINⅡ～Ⅲ为80%，其中20%为宫颈早期浸润癌。高危型HPV阳性患者阴道镜下宫颈上皮内瘤变CINⅡ～Ⅲ占60%，CINⅠ占40%；低危性HPV患者2例活检病理结果为尖锐湿疣，8例HPV阴性患者活检后病理为慢性宫颈炎。阴道镜下检查对上述四种指征的宫颈上皮内瘤病变的阳性预测值、阴性预测值分别为98.2%和75.0%，诊断准确性良好。 结论 阴道镜检查对宫颈上皮内瘤变的早期诊断，特别是高级别上皮内瘤CINⅡ～Ⅲ病变有较高的敏感性，诊断结果准确可靠，具有一定的临床价值，可有效预防宫颈癌的发生，值得在临床广泛推广和应用。
[关键词] 阴道镜；宫颈上皮内瘤变；活检；诊断价值
[中图分类号] R737.3 [文献标识码] B [文章编号] 1673-9701（2015）26-0046-03
Diagnostic value of colposcopy in cervical intraepithelial neoplasia
HUANG Yanhong MIAO Xuelian WANG Jianmin ZHANG Ting LIU Weiwei
Department of Gynaecology and Obstetrics， Liaocheng Women and Children Health， Liaocheng 252000， China
[Abstract] Objective To explore the value of colposcopy in the diagnosis of cervical intraepithelial neoplasia. Methods 3000 women who had been seeking physical examination for screening out breast carcinoma and cervical neoplasia in our hospital between May 2014 and May 2015 were selected in the primary stage， and each was given cervical thinprep cytology test （TCT） for examination. According to the TCT results， 60 patients were with cervical ASC-US， 30 cervical LSIL， 10 cases HSIL， and 20 atypical glandular cells. After that， 20 cases were selected and given HPV test. The test results showed that， 10 cases of patients were with high-risk HPV， 2 cases with low-risk HPV， and the other 8 cases were HPV negative. All patients were given VIA/VILI screening， followed by multiple punch biopsy under colposcopy， as well as ECC when necessary， according to the changes in the image. By observing the changes in the images of cervical colposcopy and the pathological results shown by the cervical biopsy， the value of colposcopy in the diagnosis of cervical intraepithelial neoplasia was analyzed. Results In terms of ASC-US patients the detection rate of chronic cervicitis by colposcopic biopsy was 66.6%， CINⅠ 26.7%， and CIN2
[关键词] 阴道镜；宫颈上皮内瘤变；活检；诊断价值
[中图分类号] R737.3 [文献标识码] B [文章编号] 1673-9701（2015）26-0046-03
Diagnostic value of colposcopy in cervical intraepithelial neoplasia
HUANG Yanhong MIAO Xuelian WANG Jianmin ZHANG Ting LIU Weiwei
Department of Gynaecology and Obstetrics， Liaocheng Women and Children Health， Liaocheng 252000， China
[Abstract] Objective To explore the value of colposcopy in the diagnosis of cervical intraepithelial neoplasia. Methods 3000 women who had been seeking physical examination for screening out breast carcinoma and cervical neoplasia in our hospital between May 2014 and May 2015 were selected in the primary stage， and each was given cervical thinprep cytology test （TCT） for examination. According to the TCT results， 60 patients were with cervical ASC-US， 30 cervical LSIL， 10 cases HSIL， and 20 atypical glandular cells. After that， 20 cases were selected and given HPV test. The test results showed that， 10 cases of patients were with high-risk HPV， 2 cases with low-risk HPV， and the other 8 cases were HPV negative. All patients were given VIA/VILI screening， followed by multiple punch biopsy under colposcopy， as well as ECC when necessary， according to the changes in the image. By observing the changes in the images of cervical colposcopy and the pathological results shown by the cervical biopsy， the value of colposcopy in the diagnosis of cervical intraepithelial neoplasia was analyzed. Results In terms of ASC-US patients the detection rate of chronic cervicitis by colposcopic biopsy was 66.6%， CINⅠ 26.7%， and CIN2