未明确意义的不典型鳞状细胞临床处理原则探讨

目的：探讨宫颈细胞学诊断ASCUS患者的临床处理原则。方法：回顾性分析2009年6月-2011年6月因宫颈细胞学诊断为ASCUS在济南市妇幼保健院行阴道镜检查加活检196例患者的临床资料,根据病理结果将患者分为四组：正常组、HPV感染组、宫颈上皮内瘤变1级（CIN1）组、宫颈癌及高度病变（CIN2-3/SCC）组,对各组的临床特征、病史、阴道镜下宫颈转化区分型及病理结果进行分析。结果：（1）正常组患者48例（24.49%）,HPV感染组患者56例（28.57%）,CIN1组患者52例（26.53%）,CIN2-3/SCC组患者40例（20.41%）。CIN2-3/SCC组中性交出血、多性伴、过早性生活、有主/被动吸烟、低文化的发生率明显高于前三组;（2）不同类型宫颈转化区患者罹患高度宫颈癌前病变及宫颈癌的几率：Ⅰ型18例（19.78%）、Ⅱ型15例（23.08%）、Ⅲ型7例（17.50%）,比较差异有统计学意义（P〈0.05）,其中Ⅱ型转化区最高。结论：对ASCUS患者的处理应强调个体化,高危因素多,经济条件低下、不能做到随访的首选阴道镜检查,转化区Ⅲ型者可首选HPV分流。

Explore the Clinical Treatment Principles of ASCUS

Objective ： To explore the clinical treatment principle of patients with ASCUS, Method： To retrospectively analyze the clinical data of 196 patients with vaginoscopy and biopsy for the cervical cytological diagnosis of ASCUS during June 2009 - June 2011 in Jinan Maternity And Child Care Hospital. According to the results of pathology, the patients could be divided into four groups： normal group, HPV infection group, cervical intraepithelial neoplasia grade 1 group （ CIN1 ）, high grade CIN and SCC group （ CIN2-3/SCC ） . To analyze the results with clinical characteristics of each group, medical history, type of cervical transformation zone under colposcopy and pathological results. Result： （ 1 ） There were 48 cases in the normal group （ 24.49% ）. 56 cases belonged to the HPVI（ 28.57% ）. In the CIN1 group, there were 52 cases（ 26.53% ）. Also,40 cases belonged to CIN2-3/SCC（ 20.41% ）. In the CIN2-3/SCC group, the occur rate was higher, such as contact bleeding/more sex/earlier sex/smoking/low-studied. （ 2 ） In patients with type I TZ, 18 cases were diagnosed CIN2-3/SCC （ 19.78% ） . In tape II TZ, there were 15 patients diagnosed CIN2-3/SCC （ 23.08% ） . However, there were 7 eases were diagnosed CIN2-3/SCC （ 17.50% ） in patients with type m. The proportion of CIN2-3/SCC was significantly different among patients with different types of TZ （ P〈0.05 ）, with type ]I highest. Conclusion： Personal therapy should be taken to the ASCUS. With high-risk factors, low- economic, eolposcope examination is the best way. With the type ~I of cervical TZ, HR-HPV should be the first way.