适宜基层地区ASCUS病例临床处理方案的探讨

Investigation on the proper clinical treatment program for ASCUS cases in the primary areas

目的:探讨适宜基层地区细胞学诊断为ASCUS病例有效的处理方法。方法:将诊断为ASCUS的896例病例分为两组,第一组543例重复细胞学检查,结果≥ASCUS病例进行宫颈活检术+组织病理学检查;第二组353例直接宫颈活检术+组织病理学检查。另外对组织病理学检查结果与各年龄段的关系进行分析。结果:第一组重复细胞学检查无上皮内病变55例、ASCUS 158例、ASC-H 39例、LSIL 255例、HSIL36例;其中488例≥ASCUS病例组织病理学检查结果炎症179例、CINⅠ200例、CINⅡ49例、CINⅢ59例、宫颈癌1例。第二组直接组织病理学检查结果炎症137例、CINⅠ134例、CINⅡ47例、CINⅢ34例、宫颈癌1例,两组组织病理学检查差异无统计学意义。≥CINⅡ的检出率与各年龄段间差异有统计学意义,40～44岁年龄段CINⅡ及以上检出率明显高于其他各年龄段,其次是35～39岁年龄段和45～49岁年龄段。结论:在基层地区细胞学诊断为ASCUS的病例可根据当地的实际情况任选一种处理方案,重点对35～49岁年龄段的病例加强临床监测。

Objective： To explore effective ways for the cases with cytological diagnosis of ASCUS in the primary areas. Methods： A total of 896 ASCUS cases were divided into two groups. The cases in the first group received repeated cytological examination, cervical bi- opsy, and histopathologic examination if the result was ASCUS or above; while the cases in the second group directly received cervical biopsy and histopathological examination. In addition, the relationship between histopathological results and difference ag groups was analyzed. Results： The cytological results of the first group： 55 cases without cervical intraepithelial lesion, 158 cases with ASCUS, 39 cases with ASC - H, 255 cases with LSIL, 36 cases with HSIL; the histological findings of 488 cases with ASCUS or above ： 179 cases with inflam- mation, 200 cases with CIN I , 49 cases with CIN Ⅱ , 59 cases with CIN Ⅲ, and one case with cervical cancer. The histopathological exam- ination of the second group： 137 cases with inflammation, 134 cases with CIN I , 47 cases with CIN Ⅱ , 34 cases with CIN Ⅲ, and one case with cervical cancer. There was no statistically significant difference in histopathological examination between the two groups, while there was statistically significant difference in the detection rate of CIN II or above among difference age groups, the detection rate of CIN 11 or above in 40 - 44 - year - old group was statistically significantly higher than those in the other age groups, followed by 35 - 39 - year - old group and 45 -49 - year old group. Conclusion：At the primary areas, the cases with ASCUS by cytological diagnosis can be treated with one of the treatment programs according to local conditions, but clinical monitoring for the cases aged 35 - 49 years old should be strengthened.