高危型HPV感染绝经后女性宫颈高级别鳞状上皮内病变的诊治

Diagnosis and Treatment of High-Grade Squamous Intraepithelial Lesion in High-Risk HPV-Infected Postmenopausal Women

高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)与高危型人乳头瘤病毒(human papilloma virus,HPV)持续感染有关,被视为宫颈癌前病变,有癌变潜能。绝经后女性由于宫颈的年龄依赖性变化,宫颈HSIL的诊治难度增加。虽然宫颈活组织检查是诊断宫颈病变的金标准,但也存在漏诊现象,然而宫颈管搔刮术可提高绝经期女性HSIL的诊断准确率,尤其阴道镜检查不满意但可疑宫颈病变时宫颈管搔刮术的效果更为显著。尽管切缘阳性被认为是宫颈切除后病变残留/复发的关键因素,切缘阴性也并不意味着病灶已被完全切除。而且因为宫颈萎缩、宫颈缩短和阴道穹窿部消失等原因使宫颈切除性手术操作困难,增加膀胱、直肠等邻近脏器损伤的风险,同时,绝经期女性激素水平降低,宫颈癌好发部位转化区内移至宫颈管内,阴道镜检查无法及时找到可疑部位,导致宫颈癌漏诊。因此,探讨针对绝经后女性宫颈病变的最优诊疗方案有重要的临床意义。通过分析绝经后女性宫颈HSIL的诊治现状及面临的难题,为绝经后妇女宫颈病变的个体化诊治提供理论指导。

High-grade squamous intraepithelial lesion(HSIL)is associated with the persistent infection of high-risk human papilloma virus,are considered cervical precancerous lesions with the potential for cancer.Difficulty of diagnosis and treatment of HSIL are increased due to age-dependent changes to the cervix in postmenopausal women.Though cervical biopsy is the gold standard for diagnosing cervical lesions,it is also missed,but endocervical curettage can improve the accuracy of HSIL in menopausal women,especially when colposcopy is not satisfactory but suspicious cervical lesions.Although positive margins are considered a key factor in residual/recurrence of lesions after cervical resection,a negative margin does not mean that the lesion has been completely removed.Moreover,because of cervical atrophy,cervical shortening,disappearance of the vaginal vault and other reasons,the difficulty of cervical resection surgery and the risk of damage to adjacent organs such as bladder and rectum are increased.At the same time,the hormone level of menopausal women is reduced,the predilection site of cervical cancer transformation zone of cervical moved to the cervical canal,and colposcopy cannot find the suspicious part in time,resulting in missed diagnosis of cervical cancer.Therefore,it is of great clinical significance to explore the optimal scheme for diagnosis and treatment of cervical lesions in postmenopausal women.By analyzing the current status and problems faced by cervical HSIL in postmenopausal,it provides individualized theoretical guidance for the diagnosis and treatment of cervical lesions in them.