【摘要】 目的 探讨≥50岁持续2年及以上低级别鳞状上皮内病变（LSIL）患者隐藏高级别鳞状上皮内病变（HSIL）的风险及诊断性子宫颈锥切术的必要性。方法 回顾性分析2013年1月至2023年10月北京大学第一医院136例≥50岁持续2年及以上LSIL女性实施诊断性子宫颈锥切术的临床资料，评估持续2年及以上LSIL者隐藏HSIL的风险及子宫颈诊断性锥切术的必要性。结果 在136例持续2年及以上阴道镜下活检为LSIL者诊断性子宫颈锥切术后病理诊断HSIL 47例（34.56%, 47/136），其中HSIL(CIN2)16例（11.76%, 16/136）,HSIL(CIN3)31例（22.79%, 31/136）；病理升级为癌0例。单因素分析显示，子宫颈锥切术后病理HSIL(CIN2+)的检出与HPV阳性（P=0.002）相关；logistic回归分析显示HPV阳性（OR=11.571, 95%CI:1.491～89.724）。单因素分析显示子宫颈锥切术后病理HSIL(CIN3)检出与年龄（P=0.045）、细胞学高级别异常（P=0.018）相关；logistic回归分析显示细胞学高级别异常（OR=2.828, 95%CI:1.237～6.469）。结论 ≥50岁持续2年及以上LSIL女性者隐藏HSIL的风险中等，对于存在高危因素者，如HPV阳性或细胞学高级别异常者建议行诊断性子宫颈锥切术。更多还原

【Abstract】 Objective To explore the risk of hiding HSIL in patients over 50 years old who have been suffering from LSIL for 2 years or more and the necessity of diagnostic cervical conization. Methods From January 2013 to October 2023, the clinical data of 136 women with LSIL who were over 50 years old and lasted for 2 years or more in Peking University First Hospital were retrospectively summarized, and the risk of hiding HSIL and the necessity of diagnostic cervical conization were evaluated. Results Among the 136 cases diagnosed as LSIL by colposcopy biopsy for 2 years or more, 47 cases(34.56%, 47/136) were diagnosed as HSIL after diagnostic cervical conization. There were 16 cases of HSIL(CIN 2)(11.76%, 16/136) and 31 cases of HSIL(CIN 3)(22.79%, 31/136). Pathology upgraded to cancer in 0 cases. Univariate analysis showed that the detection of pathological HSIL(CIN2 +) and above after cervical conization was related to HPV positive(P = 0.002), and logistic regression analysis showed that the OR value of HPV positive was 11.571(95%CI : 1.491-89.724). Univariate analysis showed that pathological HSIL(CIN3) after cervical conization was related to age(P = 0.045) and high-grade cytological abnormality(P = 0.018). Logistic regression analysis showed that the OR value of high-grade cytological abnormality was 2.828(95%CI : 1.237-6.469). Conclusions The risk of hiding HSIL is moderate in women over 50 years old with LSIL lasting for 2 years or more. Diagnostic cervical conization is recommended for those with high risk factors, such as HPV positive or high-grade cytological abnormalities.更多还原