目的探讨绝经后高级别宫颈病变[宫颈上皮内瘤变（ cervical intraepithelial neoplasia ，CIN）Ⅱ级及以上]患者的临床特点。方法回顾性分析2014年1月～2015年9月宫颈冷刀锥切手术病理确诊为CINⅡ级及以上的57例绝经后患者临床特点，年龄49～77岁，（58．2±5．6）岁，绝经时间1～36年，（9．4±6．9）年。结果①绝经后CIN Ⅱ、Ⅲ级及宫颈癌中，仅约1／5（11／57，19．3％）有阴道出血，同时近2／3（36／57，63．2％）宫颈外观光滑，无异常。②人乳头瘤病毒（human papillomavirus，HPV）分型检测39例，阳性36例，阳性率92．3％。单一HPV16型感染20例（55．6％，20／36），HPV16型合并其他高危型HPV感染7例（19．4％，7／36），其他类型高危HPV感染9例（25．0％，9／36）。③HPV分型检查中高危型HPV阳性率92．3％（36／39），HPV16阳性率69．2％（27／39），TCT检查中高度鳞状上皮内瘤变（HSIL）阳性率仅29．6％（16／54），差异有显著性（χ2＝6．686、14．286，P＝0．010、0．000）。结论绝经后妇女宫颈病变多无明显临床症状，仅依靠患者主诉和妇科检查难以判断。严格规律的宫颈病变筛查尤为重要。%Objective To investigate the clinical characteristics of postmenopausal patients with cervical intraepithelial neoplasia ( CIN) gradeⅡ/Ⅲand cervical cancer . Methods A retrospective analysis was made on the clinical characteristics of 57 cases of postmenopausal patients who were diagnosed as CIN grade Ⅱor above from January 2014 to September 2015.Their age ranged from 49 to 77 (58.2 ±5.6) years old, and the time of menopause ranged from 1 to 36 (9.4 ±6.9) years. Results ①In postmenopausal women with CIN Ⅱ/Ⅲ and cervical cancer, only about 1/5 (11/57, 19.3%) had clinical complaints, and nearly 2/3 (36/57, 63.2%) had smooth cervical appearance .②There were 36 cases of high-risk human papillomavirus ( HPV) (36/39, 92.3%), 20 cases of single HPV16 infection (20/36, 55.6%), 7 cases of HPV16 type and other high-risk HPV infection (7/36, 19.4%), and 9 cases of other types of high-risk HPV infection (9/36, 25.0%).③The positive rate of high-risk HPV was 92.3%(36/39) and the HPV16 positive rate was 69.2% (27/39).TCT examination showed a positive rate of high grade squamous intraepithelial lesion (HSIL) of only 29.6% (16/54), with significant difference (χ2 =6.686 and 14.286, P =0.010 and 0.000, respectively). Conclusions Postmenopausal women with cervical lesions usually have no obvious clinical symptoms . Gynecological examination alone is difficult to judge whether the cervical lesions exist .Strict cervical lesions screening is particularly important .
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