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目的:探讨宫腔镜下宫颈电切术(TVRC)诊断和治疗宫颈病变的效果。方法:218例宫颈病变患者,阴道镜下多点活检167例,宫颈细胞学涂片86例。218例均采用TVRC进行诊断和治疗,采用自身对照法分析TVRC治疗效果,比较TVRC术后病理检查与阴道镜下多点活检病理检查结果、宫颈细胞学涂片与阴道镜活检结果的一致性。结果:218例患者TVRC术后病理检查结果:慢性宫颈炎106例(48.62%),HPV感染20例(9.17%),宫颈上皮内瘤样病变Ⅰ级(CINⅠ)51例(23.39%),CINⅡ级23例(10.55%),CINⅢ级12例(5.50%),宫颈早期浸润癌1例(0.46%),5例(2.29%)宫颈标本CIN病变检测不能确定。阴道镜下多点活检与TVRC术后病理检查结果完全符合者88例(52.69%)。宫颈细胞学涂片检查与阴道镜活检结果完全符合者29例(39.19%)。126例平均随访18个月,无一例出现宫颈细胞学检查异常,首次TVRC术后治愈119例(94.44%),7例(5.56%)因糜烂面较大行第2次TVRC,术后治愈。结论:TVRC治疗各类宫颈病变操作简单、安全,手术时间短、出血少、治疗效果佳,且可提供足够的病理标本,对诊断、治疗宫颈病变具有极高的临床价值。
Objective: To investigate the effect of hysteroscopic cervical radiculotomy (TVRC) in the diagnosis and treatment of cervical lesions. Methods: 218 cases of cervical lesions, multi-point biopsy colposcopy 167 cases, 86 cases of cervical cytology smear. All of the 218 patients were diagnosed and treated with TVRC. The self-control method was used to analyze the therapeutic effect of TVRC. The pathological findings of TVRC and colposcopy biopsy were compared. The consistency between cervical cytology smears and colposcopy biopsies was compared. Results: The pathological results of TVRC in 218 patients were 106 cases (48.62%) with chronic cervicitis, 20 cases (9.17%) with HPV infection, 51 cases (23.39%) with CINⅠ, CINⅡ (10.55%), CIN Ⅲ grade in 12 cases (5.50%), early invasive carcinoma in 1 case (0.46%), and cervical squamous cell carcinoma in 5 cases (2.29%). Colposcope multipoint biopsy and TVRC postoperative pathological findings were fully consistent with 88 cases (52.69%). Cervical cytology smears and colposcopy biopsy results in full compliance in 29 cases (39.19%). 126 patients were followed up for an average of 18 months. None of the patients had cervical cytology abnormalities. 119 cases (94.44%) were cured after the first TVRC and 7 cases (5.56%) were treated with the second TVRC because of the erosion surface. Conclusion: TVRC is a simple and safe method to treat all kinds of cervical lesions. It has short operative time, less bleeding and good curative effect. It can provide enough pathological specimens and has very high clinical value for diagnosis and treatment of cervical lesions.