绝经后宫颈高级别鳞状上皮内病变妇女术式选择的定量指标研究  

The influence of cervical quantitative index on surgical choice in postmenopausal women with high-grade squamous intraepithelial lesions

作　　者：王爽[1,2] 徐海洋 梁华茂 王彦洁[1] 游珂[1] 耿力[1] WANG Shuang;XU Haiyang;LIANG Huamao;WANG Yanjie;YOU Ke;GENG Li(Department of Obstetrics and Cynecology,Peking Unitersity Third Hospital,Beijing 100191;Department of Obstetrics andlynecology,Shangdi Hospital,Beijing 100084;Department of Oostetries and Cynecology,the Third Peoples Hospital of Datong,DatongShanxi 037008,P.R.China)

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]北京市上地医院妇产科,北京100084 [3]大同市第三人民医院妇产科,山西大同037008

出　　处：《中国计划生育和妇产科》2021年第2期68-71,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨宫颈量化指标在绝经后宫颈高级别鳞状上皮内病变(high grade squamous intraepithelial lesions,HSIL)患者术式选择中的价值。方法回顾性分析2012年1月至2019年4月北京大学第三医院收治的50岁及以上行阴道镜检查诊断为HSIL的绝经后妇女。根据手术方式分为两组,因宫颈锥切困难而行筋膜外全子宫切除的绝经后宫颈萎缩患者41例为A组,行宫颈锥切术后再次行子宫切除术72例为B组。对比两组患者阴道镜下宫颈前后径、宫颈横径及宫颈面积。结果A组患者年龄和绝经年限均显著大于B组,宫颈各径线和宫颈面积值均小于B组,差异有统计学意义(P<0.05)。宫颈各量化指标的截断值:前后径为1.79 cm,宫颈横径为1.84 cm,宫颈面积为3.38 cm^(2)。各指标曲线下面积(AUC)对比,宫颈前后径与宫颈横径间、宫颈面积与宫颈横径间AUC差异均有统计学意义(P<0.05);而宫颈前后径与宫颈面积对比,差异无统计学意义(P>0.05)。以AUC最大的宫颈前后径1.79 cm作为截断值,则预测直接行全子宫切除术的敏感性为0.806,特异性为0.732。结论阴道镜下宫颈径线测量简单方便,对于此类患者的临床术式选择具有一定的指导意义。Objective To explore the value of cervical quantitative index on surgical choice in postmenopausal women with high-grade squamous intraepithelial lesions(HSIL).Methods A retrospective analysis was conducted in Peking University Third Hospital from January 2012 to April 2019 on postmenopausal women aged 50 years and above,who underwent colposcopy and were diagnosed as HSIL.41 patients who received extrafascial hysterectomy directly due to inability of cervical conization were assigned to group A,while 72 patients underwent cervical conization were in group B.The cervical anteroposterior diameter,transverse diameter and cervical area under colposcopy were compared between the two groups.Results The patients’age and menopause years of group A were significantly longer than those of group B(P<0.05).The cervical diameters and area in group A were all significantly smaller than those in group B(P<0.05).The cut-off value of cervical indexes:anteroposterior diameter was 1.79 cm,transverse diameter was 1.84 cm,and cervical area was 3.38 cm^(2).Compared with the area under the curve(AUC),there were statistically significant differences in AUC between cervical anteroposterior diameter and cervical transverse diameter and between cervical area and cervical transverse diameter(P<0.05),but there was no significant difference between cervical anteroposterior diameter and cervical area(P>0.05).The sensitivity and specificity of direct hysterectomy were 0.806 and 0.732 respectively when the cut-off value of cervical anteroposterior diameter was 1.79 cm.Conclusion The measurement of cervical diameter under colposcopy is simple and convenient,which has certain guiding significance for the selection of operation procedures for postmenopausal women with high-grade squamous intraepithelial lesions.

关 键 词：宫颈高级别鳞状上皮内病变 绝经 阴道镜 宫颈径线测量 全子宫切除术 

分 类 号：R713.4[医药卫生—妇产科学]