宫颈细胞学诊断低度上皮内瘤变的临床处理探讨

目的:探讨宫颈细胞学诊断低度上皮内瘤变的意义及临床处理方法。方法:对2010年5月～2011年11月在广东省中医院就诊并经TCT检查为LSIL的195例女性病例进一步行HPV-DNA-PCR检测及阴道镜检查,观察其最终病理结果的构成及在不同年龄阶段的分布差异。结果:在195例LSIL患者中,高危HPV阳性144例(73.8%),病理诊断为癌前病变及癌者共87例(60.4%);高危HPV阴性51例(26.2%),病理诊断为癌前病变及癌者共8例(15.7%)。在35岁以下的93例中,病理诊断为癌前病变及癌者共43例(46.2%);在35～45岁的69例中,病理诊断为癌前病变及癌者共41例(69.9%);45岁以上33例中,病理诊断为癌前病变及癌者共11例(33.3%)。结论:在TCT诊断为LSIL的患者中,高危HPV阳性与高危HPV阴性患者的宫颈病变检出率差异有统计学意义,不同年龄段之间宫颈病变检出率差异有统计学意义,临床处理方法及随访计划的制定与年龄及HPV感染情况有关。

Study on the clinical treatment of low-grade squamous intraepithelial lesion diagnosed by cytological test

Objective:To explore the significance of cervical cytological test for diagnosis of low-grade squamous intraepithelial lesion(LSIL) and the clinical treatment.Methods:A total of 195 female cases who were diagnosed as low grade squamous intraepithelial lesion(LSIL) by TCT in the hospital from May 2010 to November 2011 further underwent HPV-DNA PCR and colposcopy,the proportion of finally pathological results and the difference of different age distributions were observed.Results:Among 195 patients with LSIL,144 patients(73.8%) were found with positive high risk HPV,87 patients(60.4%) were diagnosed as cervical precancerous lesion and cervical cancer by pathological diagnosis;51 patients(26.2%) were found with negative high risk HPV,8 patients(15.7%) were diagnosed as cervical precancerous lesion and cervical cancer by pathological diagnosis.Among 93 patients under 35 years old,43 patients(46.2%) were diagnosed as cervical precancerous lesion and cervical cancer by pathological diagnosis;among 69 patients aged 35-45 years old,41 patients(69.9%) were diagnosed as cervical precancerous lesion and cervical cancer by pathological diagnosis;among 33 patients more than 45 years old,11 patients(33.3%) were diagnosed as cervical precancerous lesion and cervical cancer by pathological diagnosis.Conclusion:Among the patients diagnosed as LSIL by TCT,there was significant difference in the detection rate of cervical lesions between the positive high risk HPV patients and negative high risk HPV patients,there was significant difference among the patients at different groups,the formulation of clinical treatment and follow-up plan were related to HPV infection.