宫颈管病变——诊断性辅助检查

doi:10.12280/gjfckx.20200859

摘要/Abstract

摘要：

近年由于宫颈筛查的普及,与人乳头瘤病毒（human papilloma virus,HPV）感染相关的病变大多在早期被发现,而HPV不相关型宫颈病变发病率逐年上升,其中包括预后极差的胃型宫颈腺癌,病灶常位于宫颈管中上部。宫颈管病变由于其菲薄的单层柱状上皮和皱襞,发生感染的风险极大且不易清除。由于宫颈管解剖部位的特殊性,细胞学检查、病毒学检查、常规阴道镜及环形电刀切除术（loop electrosurgical excision procedure,LEEP）下活检不能保证检查的满意度及病变部位取材的完整性,容易造成漏诊,因而宫颈管病变的诊断需要更加精准。就这类病变的宫颈管取样（阴道镜下宫颈管取样、LEEP下宫颈管取样及超声下宫颈管取样）、宫腔镜以及磁共振成像等诊断性辅助检查包括部分仍存在争议的方面进行综述。

关键词: 宫颈疾病, 阴道镜检查, 超声检查, 诊断, 宫腔镜检查, 磁共振检查

Abstract:

In recent years, due to the popularity of cervical screening, lesions associated with human papilloma virus (HPV) infection are mostly detected in the early stage, while the incidence of non-HPV-associated cervical lesions is increasing year by year, including gastric type endocervical adenocarcinoma with poor prognosis, which is often located in the middle and upper part of the endocervical canal. Endocervical canal lesions have a very high risk of infection because of its thin single-layer columnar epithelium and folds. And it is difficult to remove. Due to the particularity of the endocervical canal anatomy, cytological examination, virological examination, conventional colposcopy, and loop electrosurgical excision procedure (LEEP) biopsy cannot guarantee the satisfaction of the examination and the completeness of the lesions. It is easy to cause missed diagnosis, so the diagnosis of cervical canal lesions needs to be more accurate. This article will review diagnostic auxiliary examinations for this type of disease, such as endocervical sampling (colposcopy-endocervical sampling, LEEP-endocervical sampling and ultrasound-endocervical sampling), hysteroscopy and MRI, which still covers some controversial aspects.

Key words: Uterine Cervical Diseases, Colposcopy, Ultrasonography, Diagnosis, Hysteroscopy, Magnetic resonance imaging

李娜, 孔宪超. 宫颈管病变——诊断性辅助检查[J]. 国际妇产科学杂志, 2021, 48(2): 131-134.

LI Na, KONG Xian-chao. Cervical Canal Lesions--Diagnostic Auxiliary Examination[J]. Journal of International Obstetrics and Gynecology, 2021, 48(2): 131-134.

图/表 5

图1 宫颈疾病的横断面剖面图[11]

图2 阴道镜检查注:阴道镜检查结果不满意,病灶存在于宫颈管内。A为阴道镜下宫颈外口表面可见;B为经扩张后宫颈管内可见。

图3 靶向宫颈管取样经阴道超声检查注：高回声线表示宫颈管中的细胞学采样部位;三角形为宫颈外口;箭头所指为采样部位的上端。

图4 宫腔镜检查可见的多种病灶形态注:A宫颈管有不规则形状赘生物,表面见丰富血管,呈溃疡状。B宫颈管子宫内膜异位病灶。C宫颈管处见一息肉样组织。

图5 宫颈管病变的影像学检查注：子宫颈的树莓型多囊性病变在MRI和经阴道超声检查所见。A T2加权的MRI图像显示有许多紧密聚集的小囊肿（箭头所示）,伴有高信号,有少量积液。B 经阴道超声检查显示子宫颈管有积液和高回声病灶,其中包括小囊肿（箭头所示）。

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