目 录
摘 要 1
Abstract 3
序言 5
1.研究对象与研究方法 8
1.1研究方法 8
1.2研究对象 8
1.3 统计学方法 8
2.结果 9
2.1 绝经后 HSIL 患者的一般资料 9
2.1.1 年龄分布 9
2.1.2 绝经年限统计 10
2.2 绝经后 HSIL 患者的临床表现 10
2.3 绝经后 HSIL 患者的筛查结果 11
2.3.1 HPV 分型检测结果分布 11
2.3.2 LCT 结果分布 12
2.4 绝经后 HSIL 患者的随访资料 13
2.4.1 门诊信息登记情况 13
2.4.2 患者治疗方式统计 14
2.4.3 患者手术方式统计 14
3.讨论 15
4. 结论 18
参考文献 20
综述 24
参考文献 29
致 谢 34
摘 要
目的：观察绝经期妇女高级别鳞状上皮内病变术后的临床观察及特点分析，提高对绝经后女性宫颈病变的认识；统计绝经后 HSIL 患者的随访情况，明确健康宣教、疾病管理的必要性。 方法： 收集 20XX年X月至 20XX年X月于XX医院妇产科门诊确诊高级别鳞状上皮内病变的 286 例绝经后患者的临床资料，对患者的一般资料、临床表现、筛查结果、随访资料等方面进行回顾性分析。 结果：① 286 例绝经后 HSIL 患者中，177 例患者无临床症状，占总人数的 61.89%；109 例患者有临床症状，占总人数的 38.11%，其中 65 例患者表现为阴道异常出血，占总人数的 22.73%。 ② 绝经后 HSIL 患者 HPV 感染最常见的亚型为 HPV16，其次为 HPV58、HPV52、HPV53、HPV33、HPV18 等。对 HPV 分型检测为 HR-HPV 感染的 234 例患者进行统计，发现单一 HR-HPV 感染的患者 133 例，占比 56.84%（133/234）；混合 HR-HPV感染的患者 101 例，占比 43.16%（101/234）。 ③ 绝经后女性 HSIL 的高发年龄为 51～60 岁；其绝经年限以 1～10 年居多，占总人数的 75.17%。 ④ 对 286 例患者进行电话随访，发现患者门诊信息登记真实者 193 例，占比67.48%（193/286）；信息登记不真实者 75 例，占比 26.22%（75/286）；信息登记真实性不详者 18 例，占比 6.30%（18/286）。 ⑤ 随访发现，163 例患者行手术治疗，占比 84.46%（163/193）；22 例行非手术治疗，占比 11.40%（22/193）；8 例因个人原因放弃治疗，占比 4.14%（8/193）。 ⑥ 163 例行手术治疗的绝经后 HSIL 患者中，69 例患者行宫颈锥切术，占比 42.33%（69/163）；94 例患者行全子宫切除术，占比 57.67%（94/163）。 结论： ① 绝经后 HSIL 患者门诊信息登记真实性偏低，且部分患者因个人原因未行手术治疗，应加强对其健康宣教、疾病管理，避免病情的贻误。 ② 绝经后 HSIL 患者的临床特点：（1）高发年龄为 51～60 岁；（2）绝经年限以 1～10 年居多；（3）大部分患者无明显临床症状，有症状的患者中阴道异常出血为最常见临床表现；（4）最常见 HPV 感染亚型为 HPV16，其次为 HPV58、HPV52、HPV53、HPV33、HPV18 等。
关键词：绝经；女高级别鳞状上皮内病变术；临床观察
Postoperative clinical observation and characteristic analysis of high-grade squamous intraepithelial lesions in menopausal women
Abstract
Objective: To observe the postoperative clinical observation and characteristic analysis of high-grade squamous intraepithelial lesions in menopausal women, to improve the understanding of cervical lesions in postmenopausal women; to count the follow-up status of postmenopausal HSIL patients, to clarify the necessity of health education and disease management . Methods: Collect the clinical data of 286 postmenopausal patients diagnosed with high-grade squamous intraepithelial lesions in the obstetrics and gynecology department of XX hospital from X from 20XX to X 20XX. The general information, clinical manifestations, and screening results of the patients were collected. Retrospective analysis of follow-up data and other aspects. Results: ① Among the 286 postmenopausal HSIL patients, 177 patients were asymptomatic, accounting for 61.89% of the total number; 109 patients had clinical symptoms, accounting for 38.11% of the total number, of which 65 patients showed abnormal vaginal bleeding, accounting for 22.73% of the total number of people. ② The most common subtype of HPV infection in postmenopausal HSIL patients is HPV16, followed by HPV58, HPV52, HPV53, HPV33, HPV18 and so on. The statistics of 234 patients with HR-HPV infection detected by HPV classification showed that 133 patients with single HR-HPV infection, accounting for 56.84% (133/234); 101 patients with mixed HR-HPV infection, accounting for 43.16% (101/234). ③ The high incidence of HSIL in postmenopausal women is 51 to 60 years old; their menopausal years are mostly 1 to 10 years, accounting for 75.17% of the total number. ④ A telephone follow-up of 286 patients found that 193 out-patient information was registered as true, accounting for 67.48% (193/286); 75 cases were registered with untrue information, accounting for 26.22% (75/286); information was registered as true There were 18 cases of unknown sex, accounting for 6.30% (18/286). ⑤ Follow-up found that 163 patients underwent surgical treatment, accounting for 84.46% (163/193); 22 patients underwent non-surgical treatment, accounting for 11.40% (22/193); 8 patients gave up treatment due to personal reasons, accounting for 4.14% (8/193). ⑥ Among the 163 postmenopausal HSIL patients undergoing surgical treatment, 69 patients underwent cervical conization, accounting for 42.33% (69/163); 94 patients underwent total hysterectomy, accounting for 57.67% (94/163) . Conclusion: ① The authenticity of outpatient information registration of HSIL patients after menopause is low, and some patients have not undergone surgical treatment due to personal reasons. Health education and disease management should be strengthened to avoid delays in their illness. ② Clinical characteristics of postmenopausal HSIL patients: (1) The high incidence age is 51-60 years; (2) The menopause years are mostly 1-10 years; (3) Most patients have no obvious clinical symptoms, and the vaginal abnormalities in symptomatic patients Bleeding is the most common clinical manifestation; (4) The most common HPV infection subtype is HPV16, followed by HPV58, HPV52, HPV53, HPV33, HPV18, etc.
Keywords: menopause; female high-grade squamous intraepithelial lesion surgery; clinical observation