Objective: To analyze the characteristics of high-grade squamous intraepithelial lesion (HSIL) diagnosed by cervical tissue sampling in postmenopausal women. Methods: A retrospective study was performed on 2 013 patients with HSIL diagnosed by cervical tissue sampling under colposcopy and treated by cervical conization at the First Affiliated Hospital of Zhengzhou University from June 2017 to November 2018, to compare the difference of patients' clinical features, HPV test, liquid-based thin-layer cytology (TCT), performance of colposcopy and biopsy pathology, pathology after cervical conization between 439 postmenopausal patients and 1 574 pre-menopausal patients. Results: (1) Clinical features: the proportion of contact bleeding showed no significant difference between postmenopausal patients and pre-menopausal patients [4.3% (19/439) vs 6.4% (101/1 574); χ²=2.672, P=0.102]. Among the patients with contact bleeding, the proportion of cervical cancer after cervical cone resection was significantly higher in postmenopausal patients compared with pre-menopausal patients [10/19 vs 22.8% (23/101); χ²=7.157, P=0.007]. Among the patients found by routine screening, the proportion of cervical cancer after cervical cone resection was significantly higher in postmenopausal patients compared with pre-menopausal patients [9.0% (38/420) vs 4.3% (63/1 473); χ²=14.726, P<0.01]. The proportion of smooth cervix was higher in postmenopausal patients compared with pre-menopausal patients [63.6% (279/439) vs 35.5% (558/1 574); χ²=111.601, P<0.01]. (2) High-risk HPV infection: there was no significant difference in the high-risk HPV positive rate between the postmenopausal group and the pre-menopausal group [92.0% (404/439) vs 94.4% (1 486/1 574); χ²=3.394, P=0.065]; the HPV 16 infection was the most common type, but there was no significant difference in the HPV 16 infection rate between the two groups [65.8% (289/439) vs 68.0% (1 070/1 574); χ²=0.722, P=0.395]. (3) TCT test: TCT test results included negative for intraepithelial lesion and malignancy (NILM), atypical squamous cell of undetermined signification (ASCUS), atypical squamous cells cannot exclude high-grade lesion (ASC-H), low grade squamous intraepithelial lesion (LSIL), HSIL, compared with the different results of TCT examination, there were not statistically significant difference between postmenopausal and pre-menopausal patients (all P>0.05). (4) The performance of colposcopy: the proportion of insufficient colposcopy and the proportion of cervical type Ⅲ conversion area were higher in postmenopausal patients compared with pre-menopausal patients [87.5% (384/439) vs 32.5% (511/1 574), P<0.01; 80.0% (351/439) vs 21.9% (344/1 574), P<0.01]. The proportion and positive rate of endocervical curettage (ECC) in postmenopausal patients were higher than those in pre-menopausal patients [35.3% (155/439) vs 20.4% (322/1 574), P<0.01; 67.7% (105/155) vs 53.1% (171/322), P=0.003]. The proportion of lesions involving the vaginal wall was higher in postmenopausal patients compared with pre-menopausal patients [5.9% (26/439) vs 1.0% (16/1 574); χ²=40.443, P<0.01]. There was a positive correlation between vaginal wall lesions and cervical lesions in postmenopausal patients (r=0.660, P<0.01). (5) Postoperative pathology: the positive rate of margin and the proportion of pathological escalation after cervical conization were significantly higher in postmenopausal patients compared with pre-menopausal patients [14.6% (64/439) vs 4.8% (75/1 574), 10.9% (48/439) vs 5.5% (86/1 574); P<0.01]. Conclusions: Colposcopy in postmenopausal women is often inadequate, and the cervix is mostly type Ⅲ transformation zone. The lesion in postmenopausal women is more likely to involve the cervical canal and vaginal wall. Clinical attention should be paid to cervical tube curettage and comprehensive examination of the vaginal wall. The high rate of positive margins and a high proportion of pathological upgrading after cervical conization in postmenopausal patients requires further active intervention.
目的： 探讨绝经后妇女子宫颈癌前病变的特点。 方法： 收集2017年6月至2018年11月在郑州大学第一附属医院行阴道镜下活检诊断为子宫颈高级别鳞状上皮内病变（HSIL）并行子宫颈锥切术的2 013例患者的临床病理资料，其中绝经组439例，未绝经组1 574例，对两组患者的临床特点、高危型HPV检测、液基薄层细胞学检查（TCT）、阴道镜检查及活检结果、子宫颈锥切术后病理结果等进行对比分析。 结果： （1）临床特点：绝经组接触性出血的发生率与未绝经组比较无显著差异［分别为4.3%（19/439）、6.4%（101/1 574）；χ²=2.672，P=0.102］。绝经组有接触性出血症状的患者中锥切术后病理结果为子宫颈癌的比例明显高于未绝经组［分别为10/19、22.8%（23/101）；χ²=7.157，P=0.007］；绝经组无症状的患者中锥切术后病理结果为子宫颈癌的比例也明显高于未绝经组［分别为9.0%（38/420）、4.3%（63/1 473）；χ²=14.726，P<0.01］。绝经组子宫颈表面光滑患者的比例明显高于未绝经组［分别为63.6%（279/439）、35.5%（558/1 574）；χ²=111.601，P<0.01］。（2）高危型HPV检测：绝经组患者高危型HPV阳性率与未绝经组比较无显著差异［分别为92.0%（404/439）、94.4%（1 486/1 574）；χ²=3.394，P=0.065］；两组均以HPV 16型阳性率最高［分别为65.8%（289/439）和68.0%（1 070/1 574）］，但两组比较无显著差异（χ²=0.722，P=0.395）。（3）TCT检查：TCT检查结果包括未见上皮内病变或恶性病变（NILM）、未明确诊断意义的不典型鳞状上皮细胞（ASCUS）、不除外高度病变的不典型鳞状上皮细胞（ASC-H）、低级别鳞状上内病变（LSIL）、HSIL，两组TCT检查结果分别比较，差异均无统计学意义（P>0.05）。（4）阴道镜检查：与未绝经组比较，绝经组阴道镜检查不充分的比例［分别为32.5%（511/1 574）、87.5%（384/439）］、子宫颈Ⅲ型转化区的比例［分别为21.9%（344/1 574）、80.0%（351/439）］、行子宫颈管刮取术（ECC）的比例［分别为20.5%（322/1 574）、35.3%（155/439）］、ECC阳性率［分别为53.1%（171/322）、67.7%（105/155）］均显著增高（P<0.01）；子宫颈病变累及阴道壁的比例也显著增高［分别为1.0%（16/1 574）、5.9%（26/439）；χ²=40.443，P<0.01］，且绝经组患者累及阴道壁的病变的程度与子宫颈病变的程度呈显著正相关（r=0.660，P<0.01）。（5）锥切术后病理升级情况：与未绝经组比较，绝经组患者锥切术后切缘阳性率［分别为4.8%（75/1 574）、14.6%（64/439）］、病理升级的比例［分别为5.5%（86/1 574）、10.9%（48/439）］均显著增高（P<0.01）。 结论： 绝经后妇女阴道镜检查常不充分，多为Ⅲ型转化区，病变更易累及子宫颈管及阴道壁，临床上应重视子宫颈管的搔刮及阴道壁的全面检查。绝经后妇女的锥切术后切缘阳性率高，锥切术后病理升级的比例高，常需进一步干预。.