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探讨阴道镜下宫颈多点活检联合宫颈管搔刮术对诊断宫颈病变的临床价值
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Abstract:
子宫颈恶性肿瘤(cervical cancer)是妇科最常见的恶性肿瘤，常见于50~55岁女性，近年来，随着子宫颈恶性肿瘤筛查的普及，得以早期发现和治疗子宫颈恶性肿瘤和癌前病变，目前子宫颈恶性肿瘤初筛主要是子宫颈薄层液基细胞学和(或)人乳头瘤病毒(HPV)检测→阴道镜检查→宫颈活检。然而阴道镜下宫颈活检无法采集宫颈管内病变组织，存在一定的局限性。子宫颈管搔刮术(endocervical curettage, ECC)可较充分地取得子宫颈管内病变组织，可作为子宫颈多点活检的补充。然而，ECC操作过程患者感受较痛苦，术后可能造成子宫颈管狭窄、粘连、子宫内膜异位症等医源性损伤，也增加了阴道镜多点活检的总体成本。故ECC在评估子宫颈病变中的有效性以及行ECC的指征长期存在争议。本文将通过对比近几年国内外相关研究，探讨阴道镜下宫颈多点活检联合ECC对诊断宫颈病变的临床价值。
Cervical cancer is the most common malignant tumor in gynecology, typically occurring in women aged 50 to 55. In recent years, with the widespread adoption of cervical cancer screening, early de-tection and treatment of cervical malignancies and precancerous lesions have become possible. Currently, the primary screening methods for cervical cancer include liquid-based cytology and human papillomavirus (HPV) testing, followed by colposcopy and histopathological examination. However, colposcopic cervical biopsy cannot collect tissue within the cervical canal, posing certain limitations. Endocervical curettage (ECC) can more comprehensively obtain tissue within the cervi-cal canal and serve as a supplementary method for multi-point cervical biopsy. Nevertheless, the ECC procedure may cause discomfort to patients, and postoperative complications such as cervical stenosis, adhesions, and iatrogenic injuries like endometriosis may occur, thereby increasing the overall cost of colposcopic examination. Therefore, the effectiveness of ECC in assessing cervical le-sions and the long-term controversy regarding the indications for ECC persist. This article aims to explore the clinical value of combining colposcopic multi-point cervical biopsy with endocervical curettage in diagnosing cervical lesions by comparing relevant domestic and international studies in recent years.
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