阴道镜在基层医院宫颈病变中的应用

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　　[摘要] 目的 探讨阴道镜检查在基层医院中的应用价值，尤其评估其在宫颈病变临床诊疗中的作用。 方法 将2019年6～12月在内蒙古自治区包头市中心医院就诊行阴道镜检查同时行宫颈活检术的60例患者纳入研究，对其临床资料进行回顾性分析，60例患者在行阴道镜检查前均行宫颈液基薄层细胞学检测（TCT）和高危人乳头状瘤病毒（HPV）检测，与活检术后病理结果相比较，评价阴道镜检查在宫颈病变诊断中的准确性。 结果 本研究60例患者的年龄21～72岁，平均（46.40±2.65）岁。以患者宫颈活检术后病理诊断为最终病理诊断，并作为金标准。阴道镜拟诊断为低级别鳞状上皮内瘤变者22例，高级别鳞状上皮内瘤变者28例，慢性炎症7例，宫颈浸润癌2例，阴道壁癌1例。 结论 阴道镜应用于宫颈病变的检查中，具有直观性，为临床诊断提供重要的参考依据。
　　[关键词] 阴道镜;SIL;活检;TCT;HPV
　　[中图分类号] R737.33          [文献标识码] B          [文章编号] 1673-9701（2020）21-0096-03
　　Application of colposcopy in cervical lesions in primary hospitals
　　XIAO Tianling1， 2 LI Na2
　　1.Central School of Clinical Medicine， Baotou Medical College， Inner Mongolia University of Science and Technology， Baotou 014040， China; 2.Department of Gynecology and Obstetrics， Baotou Central Hospital in Inner Mongolia Autonomous Region， Baotou 014040， China
　　[Abstract] Objective To explore the application value of colposcopy in primary hospitals， especially to evaluate its role in the clinical diagnosis and treatment of cervical lesions. Methods Sixty patients who underwent colposcopy and cervical biopsy in Inner Mongolia Autonomous Region Baotou Central Hospital from June to December 2019 were included in the study. Its clinical data were retrospectively analyzed. Sixty patients were given cervical liquid-based thin-layer cytology （TCT） and high-risk human papillomavirus （HPV） tests before colposcopy. Compared with the pathological results after biopsy， the accuracy of colposcopy in the diagnosis of cervical lesions was evaluated. Results Sixty patients in this study were 21-72 years old， with an average age of（46.40±2.65） years old. The pathological diagnosis after the patient's cervical biopsy was taken as the final pathological diagnosis， and was used as the gold standard. There were 22 cases of low-grade squamous intraepithelial lesions diagnosed by colposcopy， 28 cases of high-grade squamous intraepithelial lesions， 7 cases of chronic inflammation， 2 cases of cervical invasive carcinoma， and one case of vaginal wall cancer. Conclusion The application of colposcopy in the examination of cervical lesions is straightforward and can provide an important reference for clinical diagnosis.
　　[Key words] Colposcopy; SIL; Biopsy; TCT; HPV
　　宫颈癌（Cervical cancer，CC）在妇科恶性肿瘤中极为常见，在女性常见恶性肿瘤中，其发病率和死亡率居高不下，全球发病率及死亡率相对较高，而且发病人群呈年轻化趋势，严重影响了女性的身心健康[1，2]。子宫颈鳞状上皮内病变（Squamous intraepithelial lesion，SIL）是与宫颈癌密切相关的宫颈病变，常发生于25～45岁的女性[3]。SIL反映宫颈癌发生和发展的连续过程，尽早筛查并发现SIL，同时予以及时治疗，是预防宫颈癌的关键。阴道镜检查是临床上筛查SIL和早期宮颈癌的重要步骤之一[4]，通过阴道镜可直接将检查部位放大数倍，可清晰观察病变组织，实时可视化的评估宫颈病变，特别是子宫颈转化区（Transformation zone，TZ），以发现宫颈上皮内瘤变（Cervical intraepithelial neoplasia，CIN）、SIL和浸润癌。当然，阴道镜也可以用于评估阴道外阴和肛门的病理改变以及性侵受害者的检查等[5]。随着医疗技术的发展，电子阴道镜得到广泛的应用，便于临床医生及时发现隐藏的细微病变，已成为妇科疾病检查中不可或缺的手段。本文就基层医院中应用阴道镜检查的效果，现报道如下。
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