宫颈意义不明确非典型鳞状上皮细胞的临床意义及处理

The Clinical Significance and Treatment of Cervical Atypical Squamous Cells of Undetermined Significance

目的探讨宫颈意义不明确非典型鳞状上皮细胞（ASCUS）的临床意义及处理措施.方法收集2011年2月~2012年2月来我院就诊的TCT诊断为ASCUS的患者221例,征求患者同意后,对其进行HR-DNA检测、阴道镜检查及宫颈活组织病理检查,以病理结果为金标准,分析ASCUS的临床意义、高危HPV检测在ASCUS患者中的应用价值.结果①221例ASCUS患者病理情况分别如下：病理结果呈宫颈慢性炎症者136例（61.54%）,CINⅠ级44例（19.91%）,CINⅡ级24例（10.86%）,CINⅢ级13例（5.88%）,4例（1.81%）为浸润癌.②高危HPV检测有103例（46.61%）呈阳性,其中有47例（45.63%）病理结果为慢性炎症,CIN及宫颈癌共56例（4.37%）. HPV阴性患者118例,其中慢性炎症108例（91.53%）,CINⅠ及CINⅡ共10例（8.47%）,无CINⅢ及浸润癌.两组比较差异有统计学意义（P〈0.05）.结论 ASCUS患者中有一定比例为高度鳞状上皮病变以上的病变,应引起重视,注意ASCUS患者的治疗和随访;高危型HPV检测在ASCUS患者的处理中能起到分流、避免过度检查的作用.

Objective To analyze the clinical significance and treatment measures of cervical atypical squamous cells of undeter -mined significance（ASCUS）.Methods Two hundred and twenty-one patients tested by TCT with the diagnosis of ASCUS from 2011 Feb.to 2012 Feb.were selected as the test objects.HR-DNA test,colposcopy and cervical biopsy were conducted on the patients after getting their consent.With the histopathological findings as a gold standard ,the clinical significance of ASCUS and the value of HPV in high risk detection in ASCUS patients were analyzed.Results ①The pathologic conditions in 221 ASCUS patients were as follows：136 cases of chronic cervici-tis（61.54%）,44 cases（19.91%） of CINⅠ,24 cases（10.86%） of CINⅡ,13 cases of CINⅢgrade（5.88%）,4 cases（1.81%） of inva-sive carcinoma.②In the high risk HPV detection 103 cases（46.61%） were positive,of which 47 cases＇（45.63%） pathological findings were chronic inflammation,56 cases（54.37%） were CIN and cervical cancer .One hundred and eighteen cases were negative in the detection ,of which 108（91.53%） were chronic inflammation and 10（8.47%） were CINⅠand CINⅡ,no CIN III and invasive carcinoma .The two groups had significant difference（P〈0.05）.Conclusion A considerable proportion of ASCUS were high grade squamous epithelial lesions or even higher.In those cases,more attention should be paid on the treatment and follow-up of patients with ASCUS.Detecting high-risk HPV in pa-tients with ASCUS can play a diversion to avoid excessive examination .