绝经后妇女宫颈非典型鳞状上皮细胞转归特点分析

摘要

目的统计分析绝经妇女宫颈非典型鳞状上皮细胞（ ASCUS）的转归特点，探讨对于绝经妇女宫颈ASCUS的更合理有效的诊疗方案。方法收集2007年1月至2012年12月我院妇科门诊诊治的558例绝经后妇女及同期诊治的2927例未绝经妇女临床资料，回顾性分析研究绝经后妇女与未绝经妇女宫颈ASCUS检出率和转归及HPV感染情况。结果绝经妇女与未绝经妇女ASCUS检出率分别是6�99％（39／558）和7�31％（214／2927），无统计学差异（ P＞0�05）。 ASCUS患者中绝经组和未绝经组HPV感染率分别为20�51％（8／39）和21�96％（47／214），HPV多重感染率分别为7�69％（3／39）和5�61％（12／214），2组之间无统计学差异（P＞0�05）。在随访的33例ASCUS绝经妇女中，24例阴道镜检查呈阳性，其中宫颈高级别病变检出率为45�4％（15／33），宫颈鳞状细胞癌检出率为9�1％（3／33），显著高于未绝经妇女（ P＜0�05）。结论对绝经后妇女宫颈ASCUS病变的随访显示，宫颈高级别病变检出率和宫颈鳞状细胞癌检出率均高于未绝经妇女，提示绝经后妇女ASCUS病变更容易发展为宫颈高级别病变。临床上对于ASCUS的绝经妇女应进行宫颈薄层液基细胞等检查（ TCT）随诊和高危型HPV检测，必要时行阴道镜下宫颈活组织病理学检查。病理结果阴性者仍应定期进行宫颈细胞学随访。%Objective To explore the characteristics and outcomes of postmenopausal women diagnosed as atypical squamous cells of undetermined significance ( ASCUS) . Methods From January 1, 2007 to December 31, 2012, the data of 558 postmenopausal women and 2927 premenopausal who had thinprep cytologic test in the Baoji Maternal and Child Health Hospital were evaluated. Comparative retrospective analysis of outcomes and human papilloma virus ( HPV) infec⁃tions was carried out between postmenopausal women and premenopausal women who were diagnosed with ASCUS. Results The detection rate of ASCUS was 6�99% ( 39/558 ) and 7�31% ( 214/2927 ) respectively in postmenopausal women and premenopausal women(P>0�05). In postmenopausal women with ASCUS, the HPV infection rate and HPV multiple infection rate were 20�51% ( 8/39) and 7�69% ( 3/39) respectively, compared with 21�96% ( 47/214) and 5�61% (12/214) respectively in premenopausal women with ASCUS. The HPV infection status between postmenopausal women and premenopausal women had no statistical difference( P>0�05) . 45�4% ( 15/33) of postmenopausal women with ASCUS progressed to cervical intraepithelial neoplasia( CIN) , and 9�1% ( 3/33) progressing to cervical squamous cell car⁃cinoma. The detection rate of CIN and cervical squamous cell carcinoma in postmenopausal women with ASCUS was signifi⁃cantly higher than that in premenopausal women with ASCUS(P<0�05). Conclusions Periodical follow⁃up and HPV detection should be assessed in postmenopausal women with ASCUS. The cytology follow⁃up per 3⁃6 months should be sug⁃gested in the postmenopausal women with negative pathological results.