绝经后子宫颈低级别鳞状上皮内病变术后病理升级的临床分析

Clinical analysis of postoperative pathological escalation of low-grade intraepithelial lesions in postmenopausal cervix

目的探讨绝经后女性子宫颈低级别鳞状上皮内病变(LSIL)行宫颈环形电切除术(LEEP术)或宫颈锥切术后病理升级的危险因素,为临床决策提供依据。方法选取139例在本院门诊行经病理诊断为LSIL并已行LEEP术或宫颈锥切术的绝经后女性,对其绝经年限、液基薄层细胞学检查(TCT)、人乳头瘤病毒(HPV)各个感染型别、阴道镜检查满意度、LEEP或宫颈锥切术后病理资料进行回顾性分析。结果TCT异常率为48.9%(68/139),HPV感染率为100%(139/139),病理升级者34例(24.5%)(HSIL32例,宫颈癌2例),TCT异常对LSIL术后病理升级无预测意义(P>0.05);绝经年限≥5年、HPV16感染、阴道镜检查不满意者均有病理升级风险(P<0.05)。结论当LSIL合并绝经年限≥5年、HPV16型感染或阴道镜检查不满意,建议积极干预,可降低HSIL的漏诊率。

Objective To investigatetherisk factorsof pathological escalation after cervical circular electroresection(LEEP)or cervical conectomy for low-grade squamous intraepithelial lesions(LSIL)in postmenopausal women,and to provide evidence for clinical decision-making.MethodsA total of 139 postmenopausal women who were pathologically diagnosed with LSIL and had undergone LEEP or conectomy in our outpatient department were selected for retrospective analysis of their menopause years,liquid base thin-layer cytology(TCT),human papillomavirus(HPV)infection types,colposcopy satisfaction,and postoperative pathological data of LEEP or conectomy.ResultsThe abnormal rate of TCT was 48.9%(68/139),the infection rate of HPV was 100%(139/139),and 34 cases(24.5%)had pathological upgrading(32 cases of HSIL,2 cases of cervical cancer).The abnormal TCT had no predictive significance for postoperative pathological upgrading of LSIL(P>0.05).Patients with menopause≥5 years,HPV16 infection and unsatisfactory colposcopy had the risk of pathological escalation(P<0.05).Conclusion When LSIL is combined with menopause≥5 years,HPV16 infection or colposcopy is not satisfactory,it is recommended to actively intervene to reduce the missed diagnosis rate of HSIL.