二次活检―宫颈锥切术在子宫颈病变诊治中的临床意义
The clinical significance of the second biopsy-cervical conization in the diagnosis and treatment of cervical lesions

摘要：目的 探讨二次活检―宫颈锥切术在子宫颈病变诊治中的临床价值及应用指征。方法 选取济南军区总医院妇科2012.01-2015.10间行宫颈多点活检病理为子宫颈癌IA期及以下、采用宫颈环形电切(LEEP)术行宫颈锥切二次活检的413例患者的病例资料进行回顾性分析。结果 与宫颈多点活检比较，约10.65%(44/413)锥切术后发生病理升级，73.37%(303/413)一致，15.98%(66/413)逆转(病理级别下降和转阴)。宫颈多点活检与二次活检―宫颈锥切术在诊断宫颈低级别上皮内病变、高级别上皮内病变、早期浸润癌(IA期)方面差异有统计学意义(T=21.740，v=3-1=2，P<0.05)。锥切前高危型人乳头瘤病毒(HPV)感染的阳性率为71.91%(297/413)；锥切后病理升级的高危型HPV感染阳性率为86.36%(38/44)，未升级的为70.20%(259/369)。锥切前液基薄层细胞学(TCT)检查阳性(ASC-US及以上)为87.89%(363/413)，其中11.85%(43/363)锥切后病理升级。对锥切后病理升级与未升级的宫颈病变的高危型HPV感染阳性率、TCT检测阳性率比较，差异均有统计学意义 (χ2=5.092, P<0.05；χ2=4.476，P<0.05)。结论 二次活检―宫颈锥切术作为宫颈多点活检术诊治宫颈病变的一种再评价，能显著提高确诊率，减少隐匿性宫颈癌的漏诊，但其在临床应用时有一定的指征。
ABSTRACT: Objective To investigate the clinical value and application indications of the second biopsy-cervical conization in the diagnosis and treatment of cervical lesions. Methods We selected 413 patients from Department of Gynecology and Obstetrics, General Hospital of Jinan Military Command, who received cervical multi-point biopsy pathology IA for cervical cancer and cervical conization (LEEP knife) of the second biopsy between January 2012 and October 2015. Their data were retrospectively analyzed. Results Compared with cervical multi-point biopsy, the second biopsy-cervical conization after operation had pathological upgrade in 10.65% (44/413), agreement in 73.37% (303/413), and reverse (pathological levels drop and overcast) in 15.98% (66/413). Cervical multi-point biopsy and the second biopsy-cervical conization significantly differed in the diagnosis of cervical low-level intraepithelial lesion, high-grade intraepithelial lesions, and early invasive cancer (IA) (T=21.740, v=3-1=2, P<0.05). Before conization high-risk type HPV infection positive rate was 71.91%(297/413); after operation it was 86.36% (38/44) in upgrade pathology and 70.20% (259/369) in non-upgrade one. And thin prep cytologic test (TCT) showed that the positive rate (ASC-US and above) was about 87.89% (363/413), of which about 11.85% (43/363) was pathological upgrade after conization. The positive rates of high-risk type HPV infection and TCT result (ASC-US and above) in cervical lesions differed significantly between pathological upgrade and non-upgrade after conization (χ2=5.092, P<0.05, χ2=4.476, P<0.05). Conclusion The second biopsy-cervical conization technique as a means of reevaluation of cervical pathological changes in diagnosis and treatment of cervical biopsy under colposcopy can significantly improve diagnosis rate, reduce misdiagnosis and occult cervical cancer, but its clinical application has some indications