Abstract: Objective　To analyze the factors associated with multi-point biopsy under colposcopy in patients with cervical type Ⅲ transformation zone, compare the biopsy rates and detection rates of cervical intraepithelial neoplasia and cervical cancer, and to explore an applicable screening program for patients with cervical type Ⅲ transformation zone. Methods　A total of 400 patients with cervical type Ⅲ transformation zone taking colposcopy due to abnormal vaginal bleeding, human papilloma virus (HPV), and thin-prep cytology test (TCT) results at Clinic, Department of Gynecology, Third Affiliated Hospital of Sun Yat-sen University from January 2019 to January 2020 were selected. The ones with cervical treatment history, the pregnant ones, and the ones with no complete data were excluded; 5 cases taking diagnostic conization were excluded; and 285 cases were included for the retrospective study, and they were 22-70 (45.14±10.89) years old. The biopsy was evaluated by the colposcopy specialists in consideration of the patients' age, medical history, and screening results. Among them, 118 patients, 26-70 (47.55±10.73) years old, took routine multipoint cervical biopsy under colposcopy, and 167 patients, 22-70 (43.43±10.71) years, did not take biopsy. All data were analyzed by the SPSS 21.0 statistical software. The binary taxonomy and enumeration data were analyzed by R × C-chi square test and logistic multivariate analysis. Results　The patients' age, HPV, and TCT classification played a decisive role in the specialists' colposcopy judgment. The biopsy rate of the ≥ 50 years old group was 52.8% (57/108), which was statistically different from those of other age groups (both P<0.05). The was no statistical difference in the positive rate of biopsy between all the age groups (P>0.05). In the TCT unchecked and ASC-US group, HPV typing was related to the biopsy rate, but not to the biopsy positive rate. In all the HPV groups, TCT typing was related to the biopsy rate and positive rate. The total biopsy positive rate was 55.1% (65/118). Among them, 44 patients took loop electrosurgical excision procedure (LEEP), and 31 cases of postoperative pathology were consistent with the diagnosis of biopsy, with a coincidence rate of 70.45%. Conclusions　If the patients with cervical type Ⅲ transformation zone are ≥ 50 years old, we recommend them to take HPV and TCT screening. During multi-point colposcopy, the patients' age and TCT results should be concerned. When it is necessary, cervical dilator devices should be used and cervical curettage should be performed to avoid missed diagnosis.

Key words: Cervical type Ⅲ transformation zone, Multi-point biopsy under colposcopy, Cervical cancer, Cervical intraepithelial neoplasia

摘要： 目的　分析阴道镜下对子宫颈Ⅲ型转化区多点活检的相关影响因素，比较活检率和子宫颈上皮内瘤变、子宫颈癌的检出率，探讨对子宫颈Ⅲ型转化区患者合理分流的适用方案。方法　选取2019年1月至2020年1月于中山大学附属第三医院妇科门诊因异常阴道流血或异常人乳头瘤病毒（HPV）、液基薄层细胞学检查（TCT）结果而行阴道镜检查的子宫颈Ⅲ型转化区患者共400例，排除既往子宫颈治疗史、妊娠及资料不完整者，并剔除直接行诊断性锥切者5例，共285例患者纳入本次回顾性研究，年龄22～70（45.14±10.89）岁。由阴道镜专科医师检查，结合患者年龄、病史及筛查结果评估是否进行常规活检。其中阴道镜下行常规多点活检患者118例，年龄26～70（47.55±10.73）岁，未行活检患者167例，年龄22～70（43.43±10.71）岁。采用SPSS 21.0统计软件进行分析，二项分类资料与多项无序计数资料进行R×C卡方检验，并进行logistic多因素分析。结果　患者年龄、HPV及TCT分型均对阴道镜专科医师判断是否活检起到决定作用。以年龄≥50岁组的活检率高，为52.8%（57/108），与其他年龄组活检率比较差异均有统计学意义（均P<0.05）；各年龄组的活检阳性率差异无统计学意义（P>0.05）；在TCT未查、无明确意义的非典型细胞的改变（ASC-US）组中，HPV分型与活检率有关，但与活检阳性率无关。各HPV组中，TCT分型均与活检率有关，并且TCT的分型与活检阳性率有关。总活检阳性率为55.1%（65/118），其中44例患者行子宫颈锥形电切除术（LEEP），31例术后病理与活检诊断符合，符合率70.45%。结论　对于年龄≥50岁、子宫颈Ⅲ型转化区的患者建议行HPV和TCT联合筛查，并且在阴道镜检查时注意结合年龄及TCT结果评估是否进行多点活检，必要时使用子宫颈管扩张器及子宫颈搔刮，避免漏诊。

关键词: 子宫颈Ⅲ型转化区, 阴道镜下多点活检, 子宫颈癌, 子宫颈上皮内瘤变