【摘要】 目的:探讨重度宫颈上皮内瘤变(CINⅢ)患者子宫切除术前行宫颈环切术(LEEP)的临床价值。方法:将70例阴道镜下活检确诊为CINⅢ患者先行LEEP后行全子宫切除术,对比阴道镜活检、LEEP后病理及切缘状态与全子宫手术标本病理情况的差异。结果:阴道镜活检、LEEP后宫颈组织病理学检查结果诊断不符合率28.57%,病理升级为浸润癌5例,升级率为7.14%;子宫切除术后病理提示慢性宫颈炎39例,无病变率55.71%;LEEP切缘阳性50例中,全子宫切除术后阳性23例,阳性率46.00%,LEEP切缘阴性20例中,全子宫切除术后阳性8例,阳性率40.00%;环切切缘阳性与阴性患者发生子宫残余病灶风险差异无统计学意义(P>0.05)。结论:阴道镜下多点活检对宫颈病变存在漏诊;需要全子宫切除的CINⅢ患者,术前一定要先行诊断性环切,直接切除子宫是有风险的。更多还原

【Abstract】 Objective: To investigate the clinical value of loop electrosurgical excision procedure( LEEP) in patients with severe cervical intraepithelial neoplasia( CIN Ⅲ) before hysterectomy. Methods: Seventy patients with CIN Ⅲ diagnosed by colposcopy were treated with LEEP before hysterectomy. The pathological differences between colposcopy,LEEP edge tissue and total hysterectomy tissue were compared. Results: The disaccord rate of the pathological results between colposcopy and LEEP edge tissue was 28. 57%,and the pathology upgrading to infiltrating carcinoma in 5 cases were found,the upgrading rate of which was 7. 14%. Thirty-nine cases were diagnosed chronic cervicitis after hysterectomy,and the normal rate was 55. 71%. Among the 50 positive LEEP edge cases,23 cases were positive after hysterectomy,the positive rate of which was 46. 00%. Among the 20 negative LEEP edge cases 8 cases were posititve affter hysterectomy after hysterectomy,the positive rate of which was 40. 00%. The difference of the residual lesions risk of uterus between the positive and negative LEEP edge patients was not statistical significance( P > 0. 05). Conclusions: The multi-point biopsy under colposcope has the possibility of missed diagnosis in cervical lesions. The diagnostic LEEP in CIN Ⅲ patients should be implemented before total hysterectomy,otherwise hysterectomy is risk.更多还原