中老年患者无明确诊断意义的鳞状上皮细胞病变以上宫颈病变临床处理方法研究

目的 探讨中老年患者性质不明不典型鳞状上皮细胞（ASCUS）及ASCUS以上宫颈病变的临床处理方法.方法 根据临床对中老年患者ASCUS宫颈病变不同处理方法分组,观察1组（348例）行阴道镜检查；观察2组（316例）行高危型人乳头瘤病毒（HPV）检测,HPV阳性行阴道镜检查；观察3组（129例）定期宫颈细胞学复检,鳞状上皮内病变行阴道镜检查,比较三组临床处理情况.结果 三组574例患者同时行液基薄层细胞学检查（TCT）及阴道镜宫颈活检病理检查,结果上皮内瘤变（CIN）以上宫颈病变223例（38.9%）,其中CIN Ⅰ 136例（23.7%）、CINⅡ64例（11.2%）、CINⅢ20例（3.5%）、原位癌3例（0.5%）；观察1组348例中,行阴道镜检查348例（100.0%）,活检CINⅡ以上的患者36例（10.3%）；观察2组转阴道镜检查213例（67.4%）,活检CINⅡ以上的患者38例（12.0%）；观察3组转阴道镜检查13例（10.1%）,活检CINⅡ以上的患者3例（2.3%）.活检CINⅡ以上检出率,观察1组、观察2组差异无统计学意义（P＞0.05）,与观察3组比较差异均有统计学意义（x2 =7.014、9.156,均P＜0.05）.结论 高危型HPV检测分流ASCUS,可减少宫颈病变处理过程中误诊、漏诊及过度治疗的问题.

Study on the clinical treatment method of cervical lesions in elderly patients with ASCUS

Objective To study the clinical treatment methods for properties of unknown in elderly patients with atypical squamous cell of undertermind significant and above cervical lesions.Methods According to the clinical grouping of ASCUS in elderly patients with cervical lesions of different treatment methods,observation group 1 （348 cases） underwent colposcopy;observation group 2（316 cases） for high-risk human papillomavirus（HPV） detection,HPV positive colposcopy ;observation group 3 （129 cases） of cervical cytology examination regularly,squamous intraepithelial lesion colposcopy,compared three groups of clinical treatment.Results Liquid based cytology and three groups of 574 patients （TCT） and colposcopy and cervical biopsy,the results of intraepithelial neoplasia（C IN） above cervical lesions in 223 cases（38.9%）,in which CIN Ⅰ 136 cases（23.7%）,CIN Ⅱ in 64 cases（11.2%）,CIN Ⅲ 20 cases（3.5%）,3 cases of carcinoma in situ（0.5%） ;the group1 were observed in 348 cases,348 cases underwent colposcopy biopsy（100%）,CIN Ⅱ above 36 cases（10.3%） were observed in the group 2;213 cases of colposcopy biopsy（67.4%）,CIN Ⅱ above 38 cases （12%） were observed in the group 3 ; colposcopy examination in 13 cases （10.1%）,3 cases of biopsy CIN Ⅱ of the cases（2.3%）.Biopsy of CIN Ⅱ above the detection rate,the observation group 1,observation of the 2 groups had no significant differences（P 〉 0.05）,and observe the difference between the 3 groups was statistically significant（χ^2 =7.014,9.156,all P 〈 0.05）.Conclusion High-risk HPV detection of shunt ASCUS can reduce cervical lesions treatment process misdiagnosis,missed diagnosis and treatment of the problem of excessive.