| Objective: High Grade Squamous Intraepithelial(HSIL)is a precancerous lesions of cervix,which is closely related to cervical cancer.The aim of the study was to explore the age distribution and clinical characteristics of high grade squamous intraepithelial,clinical effect of different diagnosis methods and risk factors of positive cervical margins in order to looking for more reasonable clinical diagnosis and treatment strategy.Methods: The paper collected 215 cases of high grade squamous intraepithelial patients,56 patients with cervicitis and 54 patients with low grade squamous intraepithelial lesions(LSIL).All of them were diagnosed and treated in our hospital during Jan.2014 to Dec.2015.Through retrospectively review the clinical data analysis the age distribution,clinical characteristics and positive cervical margins' risk factors of patients with HSIL.Furthermore,analysis the clinical value of different screening and diagnosis methods by using case-control.The results were analyzed by SPSS19.0 statistical analysis software,the statistics was considered significant when p <0.05.Results: 1.Age distribution and clinical manifestation:The average age of the 215 cases with HSIL was 42.84 ±9.632 years old.The 40-44 years oldphase was the high-incidence age phase and it accounted for 18.6% of the total number.Furthermore,in the 215 cases,there were only 28.37%patients with clinical symptoms and the main clinical symptoms was contact hemorrhages.2.Screening methods:The infection status and types of HPV were closely related to the occurrence of cervical intraepithelial neoplasia,but multiple HPV infection has not directly related with it.With the increasing of cervical lesion degree,multiple HPV infection rate was on the decline,but HPV overall infection rate and HPV16/18 infection rate was on the rise.In patients with CIN,the positive rate of high-risk HPV was 95.52%(192/201)and TCT 's positive rate was 79.32%(188/237),accuracy was69.6%(204/293).The results show that the sensitivity of TCT testing,HPV testing and joint testing was 79.41%,94.83% and 98.85%;rate of missed diagnosis was 20.59%,5.17% and 1.15%.The different results between the three kinds of screening strategy had statistically significant(chi-square X2=4.530;3.932;23.762,P=0.038;0.047;0.006<0.0).3.Positive cut edge:In the postoperative cervical specimen of cold knife cut,there were 10 case of cut edge positive.The positive rate was5.43%.Analysis the related risk factors of cut edge positive.The results show that glandular extension(P0.030 OR-,95PI%-)and multiple quadrant lesion(P0.039,RR4.382,95%PI1.076-17.852)had statistically significant for positive cervical edge.Conclusion:1.HSIL often happens in women aged 40 to 44 and most of them haven't obvious clinical manifestations,but contact hemorrhages havethe effect of implication for the diagnosis of HSIL.2.High-risk HPV infection is closely related to cervical intraepithelial lesions.Multiple HPV infection did not increase the incidence of cervical cancer.The happening and development of CIN tend to caused by single high-risk HPV infection and 16 or 18 subtypes HPV has the highest correlation.3.High-risk HPV joint TCT testing is the best screening strategy for cervical screening and it has significant clinical value.4.Glandular extension and multiple quadrant diseases is the risk factors of positive cervical margins after cold knife cut method. |
PDF Full Text Request