本文選題：電子陰道鏡 + 宮頸病變��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：將陰道鏡診斷與陰道鏡下活組織檢查后的病理診斷進(jìn)行對(duì)比，并總結(jié)異常陰道鏡圖像與宮頸病變的關(guān)系，評(píng)估電子陰道鏡對(duì)宮頸病變的診斷價(jià)值，，探討其臨床意義。方法：回顧性分析大連醫(yī)科大學(xué)附屬第一醫(yī)院婦科門(mén)診2011年1月至2013年8月之間行陰道鏡檢查并活檢的863例患者的一般資料和陰道鏡圖像，對(duì)患者陰道鏡診斷與活檢或手術(shù)的病理診斷進(jìn)行對(duì)比分析。結(jié)果：陰道鏡下檢查并活檢863例，陰道鏡擬診為正常/慢性宮頸炎的共459例，CINI的共174例，CINII的127例，CINIII的103例，病理結(jié)果示正常/慢性宮頸炎523例，CINI132例，CINII100例，CINIII108例；陰道鏡診斷與病理診斷的總體符合率為83.31%。陰道鏡對(duì)宮頸病變總體診斷符合率為71.78％，靈敏度為85．29％，特異度為79．01％，假陽(yáng)性率為20．99％，假陰性率為14．71％。其中對(duì)CINI的診斷符合率為60.92%，靈敏度為80.30%，特異度為90.70%，假陽(yáng)性率為9.30%，假陰性率為19.70%；對(duì)CINII-III的診斷符合率為80.00%，靈敏度為88.46%，特異度為94.66%，假陽(yáng)性率為5.34%，假陰性率為11.54%。陰道鏡擬診結(jié)果與病理診斷結(jié)果存在較高度的一致性（Kappa系數(shù)=0.729，P=0.000）。陰道鏡對(duì)CINII-III的診斷符合率、靈敏度、特異度均明顯高于對(duì)CINI的診斷符合率、靈敏度、特異度（P＜0.05）。結(jié)論：陰道鏡在宮頸病變?cè)\斷中具有重要應(yīng)用價(jià)值；陰道鏡下出現(xiàn)致密醋酸白上皮、鑲嵌、白斑等改變意味高級(jí)別病變可能性大，應(yīng)高度警惕；陰道鏡對(duì)低級(jí)別病變（≤CINI）的過(guò)度診斷率（5.33%）和重度病變（CINIII）的診斷不足率（0）均很低，有利于避免過(guò)度診斷或漏診，但對(duì)中度病變（CINII）診斷不足的可能性較高（27.55%），有待于研究和提高；陰道鏡對(duì)CINI診斷不足率為35.06%，提示對(duì)陰道鏡擬診為正�；蚵匝装Y者應(yīng)結(jié)合HPV結(jié)果綜合判斷正確隨診。
[Abstract]:Objective: to compare the pathological diagnosis of colposcopy with that of biopsy under colposcopy, summarize the relationship between abnormal colposcopy and cervical lesions, evaluate the diagnostic value of electronic colposcopy for cervical lesions, and discuss its clinical significance. Methods: the general data and colposcopy images of 863 patients who underwent colposcopy examination and biopsy from January 2011 to August 2013 in gynecological outpatient department of the first affiliated Hospital of Dalian Medical University were analyzed retrospectively. The colposcopy diagnosis was compared with the pathological diagnosis of biopsy or operation. Results: under colposcopy, 863 cases were examined and biopsy, 459 cases of CINI were diagnosed as normal / chronic cervicitis under colposcopy, 127 cases of CINII were diagnosed as CINII, and 103 cases of CINIII were detected. Pathological results showed that 523 cases of normal / chronic cervicitis had CINI (132 cases) and 100 cases of CINIII (108 cases). The overall coincidence rate between colposcopy and pathological diagnosis was 83.31. The overall diagnostic coincidence rate of colposcopy for cervical lesions was 71.78, the sensitivity was 85.299.29, the specificity was 79.01, the false positive rate was 20.99, and the false negative rate was 14.71. The diagnostic coincidence rate for CINI was 60.92, the sensitivity was 80.30, the specificity was 90.70, the false positive rate was 9.30 and the false negative rate was 19.70.The diagnostic coincidence rate for CINII-III was 80.00,88.46 and the specificity was 94.666.The false positive rate was 5.34and the false negative rate was 11.54B. There was a high consistency between the results of colposcopy and pathological diagnosis. The diagnostic coincidence rate, sensitivity and specificity of colposcopy for CINII-III were significantly higher than those for CINI (P < 0.05). Conclusion: colposcopy has important application value in the diagnosis of cervical lesions, the appearance of dense white acetate epithelium, mosaic and white spot under colposcopy means that the possibility of high grade lesions is high, and we should be on high alert. The rate of overdiagnosis of low grade lesions (鈮

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