宫颈病变不同检查方法的年龄别对比研究

目的对比研究宫颈病变细胞学和组织学诊断在不同年龄组中的特点，寻求临床科学管理方法。方法回顾分析2003年5月-2008年8月细胞学诊断低度鳞状上皮内病变（LSIL）并行阴道镜下活检和（或）子宫颈环切术（LEEP）病例，年龄分层后对比细胞学、组织学诊断符合情况。结果549例LSIL高危型人乳头状瘤病毒（HR—HPV）感染牢53．6％．≤50岁组感染率为54．5％显著高于〉50岁组的31．8％（P〈0．05）；细胞学与活检组织学诊断符合率为56．6％．≤50岁组的诊断符合率为57．7％显著高于〉50岁组的31．8％（P〈0．05）；高等级宫颈上皮内瘤变（C1N2以上）57例（10．4％）。全部发生于〉30岁妇女；LEEP38例，其组织学诊断与阴道镜活检组织学诊断符合7例（25．9％）．其中≤30岁组符合率为71．4％显著高于〉30岁组的10．0％（P〈0．01）。结论与组织学诊断对比，细胞学诊断LSIL对≤50岁妇女准确性较高；阴道镜对〉30岁妇女的CIN易漏诊；30岁以上妇女是宫颈癌高风险人群。在宫颈癌前病变管理中应充分考虑妇女年龄因素。

Age-special Comparative Study of Uuterine Cervical Disease in Different Diagnostic Methods

Objective To study the characteristics uterine cervical disease in different age group woman of cytology and histopathology diagnoses in and seek for scientific management. Methods 549 cases of LSIL （Low-Grade Squamous Intraepithelial Lesion） were retrospectively investigated,who had been diagnosed with liquid-based cytology method and underwent colposcopic punch biopsies,and 8 of whom underwent LEEP（loop electro-excisional procedure）. The results from cytology and histopathology diagnosis were compared based on different ages. Results Of the 549 patients the HR-HPV infection rate was 53.6G. The rate in the ≤50 and 〉50 age group was respectively 54.5G and 31.8G which showed significant difference （P〈0.05）. Coincidence rate of cytology and punch biopsy histopathology diagnosis results was 56.6 %. The coincidence rate in the ≤50 and 〉50 age group was 57.7% and 31.8% respectively which showed significant difference too （P〈0.05）. 57（10.4%）cases of CIN2 （cervical intraepithelial neoplasia grade 2） and above which occurred in ）30 age group women. The coincidence rate of punch biopsy and LEEP was 25.9%. the coincidence rate in ≤30 and 〉30 age groups was respectively 71.4% and 10.0% which showed significant difference （P〈0.01）. Conclusions Compared with the histopathology diagnosis based on colposcopic punch biopsies, cytology diagnosis is more accurate in ≤ 50 age women with LSIL. Colposcopy is apt to miss CIN and above diagnosis in 〉30 at high risk of contracting cervical cancer. Woman ages should be taken into management of cervical cancer precursor lesions.