Analysis Of The Characteristics And Surgical Methods Of High-grade Squamous Intraepithelial Lesions In Postmenopausal Women

Objective:Analyze and discuss the clinical characteristics and diagnosis and treatment of postmenopausal patients with high-grade squamous intraepithelial lesions(HSIL),and provide necessary reference for the prevention,screening and treatment of cervical diseases in postmenopausal people.Methods:By collecting and collating the basic clinical data of 294 postmenopausal hospitalized patients who were diagnosed as high-grade squamous intraepithelial lesions of the cervix by colposcopic cervical biopsy from January 1,2016 to December 31,2018 in the Department of Gynecology,Affiliated Hospital of Inner Mongolia Medical University,Retrospective analysis of clinical characteristics,surgical methods and postoperative pathology.Results:(1)The age of onset of postmenopausal cervical high-grade squamous intraepithelial lesions was 46-77 years,with an average age of(57.1±5.87)years,and the menopause time ranged from 1 to 39 years,with an average of(7.42±6.19)years.The number of rural patients(49.7%)Were similar to those of urban patients(50.3%);most of them had primary education and below,accounting for 42.2%,the difference was statistically significant(X~2=7.36,P=0.012);there were significant differences in the distribution of different occupations(X~2=15.07,P=0.003),the occupations of most patients are farmers and unemployed persons.(2)Of all postmenopausal patients,10.5%(31/294)had contact contact,24.1%(71/294)had irregular vaginal bleeding,and 65.3%(192/294)had no abnormal clinical symptoms,and only passed a physical examination TCT and/or HPV were found abnormal,and the differences between the three groups were statistically significant(X~2=26.946,P=0.015);61.9%(182/294)of the postmenopausal patients showed atrophic cervix,and non-atrophic state accounted for 38.1%(112/294);the smooth appearance of the cervix accounted for60.5%(178/294),the epithelial erosion accounted for 39.5%(116/294),there was a significant difference between the two(X~2=35.829,P=0.036).(3)Among patients with postmenopausal high-grade cervical lesions,the difference in the composition ratio of TCT examination results was statistically significant(X~2=41.749,P<0.001),and the results of each patient were mostly NILM.There were 276 HPV-positive patients.Among HPV-positive patients,high-risk HPV infections accounted for 99.64%(275/276).HPV16-type infections(58.2%)were the most common,of which single HPV16-type infections accounted for 32.0%(88/275),HPV16 combined with other high-risk HPV infections accounted for 26.2%(72/275);while other types of high-risk HPV infections accounted for 41.8%(115/275),HPV16 infection was significantly higher than other types of high-risk HPV infections(X~2=9.417,P=0.021).(4)Of the 294 patients with high-grade squamous intraepithelial lesions of the postmenopausal cervix,186 patients underwent cervical coneectomy.The preoperative and postoperative pathology were 65.1%(115/186),and 3 patients(1.61%,3/186),22 cases with positive margin(11.83%,22/186);the remaining 108 patients underwent total hysterectomy,of which 64.8%(70/108)were consistent with preoperative and postoperative pathology,and7 cases were upgraded(6.5%,7/108),2 cases with positive resection margin(1.85%,2/108),the pathological consistency rate was higher in both groups after surgery;the positive rate of resection margin after cone resection was significantly higher than that after total hysterectomy.Positive margin resection rate(X~2=48.85,P<0.001);the pathological escalation rate was significantly different between the two groups after surgery(X~2=7.375,P<0.05),and the escalation rate was higher after total hysterectomy.Conclusions:(1)Postmenopausal women with cervical lesions often have no obvious clinical symptoms and signs.It is difficult to determine the presence or absence of lesions only based on the patient’s complaint and gynecological examination.Therefore,strict regular cervical cancer screening is particularly important;(2)High-risk HPV infection rates are still high in postmenopausal women,with HPV16infection being the most common.Therefore,screening and management of cervical high-risk HPV in this special group of postmenopausal women should be strengthened;(3)The first choice for postmenopausal cervical high-grade squamous intraepithelial lesions is cervical coneectomy.For patients with severe cervical atrophy who are difficult to perform coneectomy,or for patients with other gynecological related diseases,the whole uterus can be selected Resection,but invasive cancer should be excluded to the greatest extent before surgery.