未明确诊断意义的宫颈非典型鳞状上皮细胞病变1116例临床分析

Undiagnosed cervical atypical squamous cell lesion: clinical analysis on 1 116 cases

【目的】分析宫颈液基细胞检查结果为意义未明确的非典型鳞状上皮细胞病变(ASCUS)者的宫颈病变情况,探讨ASCUS的临床意义及处理。【方法】对1 116例液基细胞学检查结果为ASCUS的病例进行人乳头瘤病毒(HPV)分型检测及阴道镜检查,可疑部位做阴道镜下多点活检,外观未见异常者行宫颈管搔刮,对病理检查结果进行统计分析。【结果】1 116例ASCUS中,HPV高危型540例,HPV低危型2例,HPV感染率为48.57%(542/1 116),阴道镜活检或宫颈管搔刮检出慢性宫颈炎827例,扁平湿疣116例,尖锐湿疣2例,宫颈上皮内低度病变84例,宫颈上皮内高度病变79例,宫颈鳞癌8例。ASCUS妇女中,宫颈病变(除慢性宫颈炎外)检出率为25.90%(289/1 116),其中高度病变检出率为7.08%,宫颈鳞癌检出率为0.72%。【结论】临床上可以通过HPV分型检测分流出ASCUS中宫颈病变的高危人群,从而减少不必要的阴道镜检查及活检,减轻患者的心理负担和医疗资源浪费。

[Objective]To investigate the clinical significance and treatment of atypical squamous cell lesions（ ASCUS） in cervical lesions by analyzing liquid based cytology test in ASCUS. [Methods] All1 116 patients with ASCUS were done with HPV typing test and colposcopy,suspicious sites were done with colposcopy biopsy or cervical tube scraping. Pathological examination results were statistically analyzed. [Results]Of the 1 116 patients with ASCUS,540 were in high-risk of HPV,2 were in low-risk HPV. HPV infection rate was 48. 57%（ 542/1 116） and colposcopic biopsy or neck tube scratch curettage and pathological found 827 cases of chronic cervicitis,116 cases of flat condyloma,2 cases of condyloma acuminatum（ CA）,84 cases of LSIL（ cervical intraepithelial low-grade lesions）,79 cases of HSIL（ cervical intraepithelial high-grade lesion）,and 8 cases of cervical squamous cell carcinoma. In ASCUS women,the incidence of cervical lesions was 25. 90%（ 289/1 116）,where the incidence of HSIL was7. 08%,and the incidence of cervical squamous cell carcinoma 0. 72%. [Conclusion] Clinically HPV genotyping can detect the high-risk population with ASCUS,thus reducing unnecessary colposcopy and biopsy,and decreasing the psychological burden of the patients and the waste of medical resources.