本文選題：宮頸癌 + 宮頸上皮內(nèi)瘤變�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：背景:宮頸癌在世界范圍內(nèi)的發(fā)病率及死亡率均較高,且呈年輕化趨勢,嚴(yán)重影響女性的身心健康。而宮頸癌是唯一有明確病因的惡性腫瘤,減少宮頸癌發(fā)病率及死亡率的重點(diǎn)在于宮頸癌尤其是宮頸上皮內(nèi)瘤變(cervical intraepithelial neoplasia,CIN)的篩查。陰道鏡檢查是臨床上篩查CIN和早期宮頸癌的重要步驟之一,且直接影響患者的診療方案,廣泛地用于宮頸癌的篩查。而在現(xiàn)有報(bào)道中,陰道鏡檢查的診斷價(jià)值不盡一致。目的:探討陰道鏡檢查的診斷價(jià)值,評估其在宮頸病變臨床診治中的作用。方法:回顧性分析2015-09至2016-10在青島大學(xué)附屬醫(yī)院嶗山院區(qū)就診行陰道鏡檢查同時(shí)行宮頸活檢,并根據(jù)陰道鏡圖像及活檢病理結(jié)果最終行宮頸環(huán)形電切術(shù)(LEEP)、宮頸錐切術(shù)或全子宮切除術(shù)的536例患者的臨床資料。采用自身對照,對這些患者的一般資料、陰道鏡圖像特征、宮頸活檢病理及最終病理資料指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:本研究中536例患者的年齡分布為19~75歲,平均年齡32.9±3.4歲,平均孕2.8±0.4次,產(chǎn)1.7±0.3次。以患者宮頸活檢病理及LEEP或?qū)m頸錐切術(shù)或全子宮切除術(shù)后病理的最高病理診斷為最終病理診斷,并作為診斷標(biāo)準(zhǔn)。陰道鏡圖像診斷為高度鱗狀上皮內(nèi)病變(high-grade squamous intraepithelial lession,HSIL)及以上的病例共364例,低度鱗狀上皮內(nèi)病變(low-grade squamous intraepithelial lession,LSIL)及以下病例共172例。陰道鏡圖像擬診斷與最終病理診斷的總體符合率為72.20%(387/536),診斷不足的有111例(20.71%),診斷過度的有38例(7.09%)。陰道鏡圖像擬診斷為HSIL及以上、LSIL及以下的病例與最終病理診斷的總體符合率分別為89.56%(326/364)、35.47%(61/172),I型、II型、III型轉(zhuǎn)化區(qū)患者陰道鏡圖像擬診斷與最終病理診斷的符合率分別為:78.73%、71.52%、57.27%(X~2(I,II)=2.84 P㧐0.05,X~2(II,III)=4.30 P㩳0.05,X~2(I,III)=18.01 P㩳0.05)。宮頸活檢病理為低級別病變及以下的為139例,為高級別病變的共397例,宮頸活檢病理與最終病理診斷的總體符合率為90.49%(485/536),診斷不足的有51例(9.51%),宮頸活檢病理診斷為HSIL、LSIL及以下的病例與最終病理診斷的總體符合率分別為:96.98%(385/397)、71.94%(100/139),無宮頸活檢病理為宮頸浸潤癌的病例。I型、II型、III型轉(zhuǎn)化區(qū)患者宮頸活檢病理與最終病理診斷的符合率分別為:94.03%、91.14%、80.91%(X~2(I,II)=1.27 P㧐0.05,X~2(I,III)=15.20 P㩳0.05,X~2(II,III)=5.98 P㩳0.05)。結(jié)論:(1)陰道鏡圖像擬診斷、宮頸活檢病理與最終病理診斷均有較高的符合率,陰道鏡圖像及陰道鏡指導(dǎo)宮頸活檢對宮頸病變均有較高的診斷價(jià)值,同時(shí)應(yīng)提高對陰道鏡圖像診斷不足的認(rèn)識(shí)。(2)宮頸轉(zhuǎn)化區(qū)類型影響陰道鏡檢查診斷準(zhǔn)確性,宮頸I型及II型轉(zhuǎn)化區(qū)患者診斷符合率高于III型,而I型、II型之間診斷符合率無明顯統(tǒng)計(jì)學(xué)差異。(3)陰道鏡對宮頸高級別病變的診斷符合率高于低級別病變。
[Abstract]:Background: the incidence and mortality of cervical cancer in the world are higher and younger, which seriously affects the physical and mental health of women. Cervical cancer is the only malignant tumor with definite etiology. The focus of reducing the incidence and mortality of cervical cancer lies in the screening of cervical cancer, especially cervical intraepithelial neoplasms. Colposcopy is one of the important steps in clinical screening of CIN and early cervical cancer, which directly affects the diagnosis and treatment of patients and is widely used in cervical cancer screening. In current reports, the diagnostic value of colposcopy is not consistent. Objective: to evaluate the value of colposcopy in the diagnosis and treatment of cervical diseases. Methods: cervical biopsy was performed by colposcopy in Laoshan Hospital of Qingdao University from September to October 2016-2015-2016-10. The clinical data of 536 cases of cervical circumferential electroresection, cervix conization or hysterectomy were performed according to the colposcopy and biopsy results. The general data of these patients, the features of colposcopy, the pathological and final pathological data of cervical biopsy were analyzed statistically. Results: the age distribution of 536 patients in this study was 1975 years old, with an average age of 32.9 鹵3.4 years, an average of 2.8 鹵0.4 pregnancies and 1.7 鹵0.3 births. The final pathological diagnosis was based on the highest pathological diagnosis of cervical biopsy and LEEP or cervical conization or total hysterectomy. A total of 364 patients with high-grade squamous intraepithelial lesions and above were diagnosed by colposcopy, and 172 patients with low-grade squamous intraepithelial lesions (LSILs) and below were diagnosed by colposcopy. The overall coincidence rate between colposcopy image diagnosis and final pathological diagnosis was 72.20 / 536%, 111 cases were underdiagnosed and 38 cases were over diagnosed. The overall coincidence rate of colposcopy with final pathological diagnosis was 89.56 / 326364 / 35.4761 / 172M / I / II conversion zone and final pathological diagnosis, respectively. The coincidence rates of colposcopy imaging and final pathological diagnosis were 78.7373 / 71.5222T / 77.277.277.277.272X ~ (2.84) ~ (2.84) P ~ (0.05) P ~ (0.05) P ~ (0.05) P ~ (0.05) P ~ (0.05) I ~ (2) and 18.01 ~ (0.05) P ~ (0.05) P ~ (0.05) respectively for colposcopic imaging and final pathological diagnosis of the patients with colposcopy and above LSIL (n = 8). The accuracy of colposcopy imaging was as follows:% 78.73% 71.522SIL ~ (2.84) P0. 084 P0. 084 P0. 0. 30 P0. 05 P0. 05. The pathology of cervical biopsy was 139 cases of low grade lesions and below, and 397 cases of high grade lesions. The overall coincidence rate between cervical biopsy pathology and final pathological diagnosis was 90.4995 / 536g, 51 cases (9.51g) were underdiagnosed. The overall coincidence rate of cervical biopsy pathological diagnosis of HSILLSIL and below with final pathological diagnosis was: 1% 96.98% 385% 3977.94% 100% 139m without cervical biopsy pathology. The coincidence rates of cervical biopsy pathology and final pathological diagnosis in patients with type I invasive carcinoma of type I type II or type III were 91.03 and 91.14, respectively. The diagnostic accuracy of cervical biopsy was 1.27 P1. 27 P0. 05 P0. 05 X2 IH2 and 15. 20 P0. 05 X2. III1 + 5. 98 P0. 05. Conclusion there is a high coincidence rate between cervical biopsy pathology and final pathological diagnosis in colposcopy image. The colposcopy image and colposcopy guiding cervical biopsy have high diagnostic value for cervical lesions. At the same time, we should improve the understanding of the insufficient diagnosis of colposcopy. 2) the type of transformation area of cervix affected the diagnostic accuracy of colposcopy. The diagnostic coincidence rate of patients with type I and type II conversion area was higher than that of type III. However, there was no significant difference in the diagnostic coincidence rate between type I and type II (P < 0.05). The diagnostic coincidence rate of high grade cervical lesions by colposcopy was higher than that of low grade lesions.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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本文編號：1846920