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目的:通过对高级别宫颈上皮内瘤变(CIN)锥切后切缘阳性的患者术后4~6周行阴道镜检查,探讨阴道镜检查对处理切缘阳性患者的临床价值。方法:选取2012年1月至2012年12月在南京医科大学第一附属医院宫颈病中心就诊并行宫颈环形电切术(LEEP)的CINⅡ~Ⅲ且切缘阳性的80例患者,术后4~6周均行阴道镜检查(接受活检或颈管掻刮),其中未发现异常者71例(研究组),9例≥CINⅠ病变残留;切缘阴性者137例(对照组)。研究组与对照组均于LEEP术后6个月复诊以评估病变残留。结果:(1)切缘阳性的80例患者中,锥切术后初次阴道镜检查发现9例≥CINⅠ病变残留,接受再次锥切或全子宫切除,最终发现3例CINⅠ、5例CINⅡ~Ⅲ及1例宫颈浸润癌。(2)术后6个月HR-HPV检测阳性47例中,病变残留6例;宫颈细胞学检查≥ASCUS 18例中,病变残留3例;HR-HPV、宫颈细胞学检测病变残留的敏感性分别为100%、50%,特异性为79.70%、91.35%。(3)对照组、研究组的病变残留率分别为2.19%(3/137)、4.23%(3/71),两组比较差异无统计学意义(P<0.05)。(4)锥切术后4~6周行阴道镜检查对切缘阳性患者病灶残留的阴性预测值为95.77%(68/71),且无一例病理升级或浸润癌的发现。结论:术后早期阴道镜检查对锥切切缘阳性者具有可行性及实用性,不仅能及时发现病变残留并得以及时处理,且有较高的阴性预测价值,检查结果阴性者随访安全性高。
OBJECTIVE: To evaluate the clinical value of colposcopy in the treatment of patients with positive margins by colposcopy after 4 to 6 weeks after conization of high-grade cervical intraepithelial neoplasia (CIN). Methods: From January 2012 to December 2012, 80 patients with CINⅡ ~ Ⅲ positive margins in LEEP were enrolled in the Department of Cervical Disease, the First Affiliated Hospital of Nanjing Medical University from January 2012 to December 2012, Six patients underwent colposcopy (biopsy or neck scraping). No abnormalities were found in 71 patients (study group), 9 patients with ≥CINⅠ lesions, and 137 patients with negative margins (control group). The study group and the control group were reviewed at 6 months after LEEP to assess the residual lesions. Results: (1) Of the 80 patients with positive margins, the first colposcopy after conization found that 9 cases of ≥CIN Ⅰ lesions were left for conization or total hysterectomy. Finally, 3 cases of CIN Ⅰ and 5 cases of CIN Ⅱ ~ Ⅲ And 1 case of invasive cervical cancer. (2) Among the 47 cases with positive HR-HPV test at 6 months after operation, 6 cases remained lesions, 3 cases of cervical cytology ≥ASCUS, 3 cases of residual lesions, and HR-HPV and cervical cytology Respectively, 100%, 50%, specificity of 79.70%, 91.35%. (3) The residual rate of the control group and the study group were 2.19% (3/137) and 4.23% (3/71), respectively. There was no significant difference between the two groups (P <0.05). (4) The negative predictive value of residual colposcopy in patients with positive margins at 4 ~ 6 weeks after conization was 95.77% (68/71), and no pathological upgrade or invasive carcinoma was found. CONCLUSION: Early postoperative colposcopy is feasible and practicable for patients with positive conization margins, which not only can detect the residual lesions promptly but also treat them promptly, and has high negative predictive value. The results of negative colposcopy are safe and follow-up.