【摘要】 目的 分析绝经前与绝经后女性宫颈高级别鳞状上皮内病变情况及临床特征。方法 收集2021年1月至2023年12月于安阳市妇幼保健院因宫颈活检确诊为HSIL并接受子宫颈锥切术的1 560例患者资料，按绝经状态分为绝经前组（n=922）和绝经后组（n=638）。比较两组的临床症状、激素水平、临床病理指标、HPV高危险类型、TCT检查结果、手术方式选择及术后复发率情况。结果 绝经后组出现接触性出血的比例明显高于绝经前组，差异有统计学意义（P<0.05），两组白带异常、盆腔疼痛等症状比较差异无统计学意义（P>0.05）。绝经后组LH、FSH水平明显高于绝经前组，E2、T、E2/T显著低于绝经前组，差异有统计学意义（P<0.05）。绝经后组阴道镜检查不充分率、子宫颈转化区为Ⅲ型、子宫颈管刮取术阳性率、阴道壁累及阳性率、切缘阳性率、病理升级率显著高于绝经前组，差异有统计学意义（P<0.05）。绝经后组HPV 16型阳性率显著高于绝经前组，差异有统计学意义（P<0.05），两组其他类型的高危HPV感染阳性率比较差异无统计学意义（P>0.05）。绝经前组的细胞学正常率高于绝经后组，而绝经后组HSIL发生率高于绝经前组，差异有统计学意义（P<0.05）。绝经后组患者选取LEEP术的比例显著低于绝经前组，而选择宫颈切除术患者则高于绝经前组，且术后复发率明显高于绝经前组，差异有统计学意义（P<0.05）。结论 绝经后女性与绝经前女性在HPV感染类型、阴道镜评估及术后复发等方面存在差异，需加强绝经后女性高危HPV治疗后的长期随访与干预。更多还原

【Abstract】 Objective Analysis of the situation and clinical characteristics of high-grade squamous intraepithelial lesions of the cervix in pre-and post-menopausal. Methods Clinical data from 1,560 patients diagnosed with HSIL by cervical biopsy and treated with conization at Anyang Maternal and Child Health Hospital between January 2021 and December 2023 were collected. Patients were divided into premenopausal(n=922) and postmenopausal(n=638) groups. The clinical symptoms, hormone levels, clinical pathological indicators, high-risk HPV types, TCT results, surgical method choices, and postoperative recurrence rates of two groups were compared. Results Postmenopausal women had significantly higher rates of contact bleeding, but no significant difference in leucorrhea abnormalities or pelvic pain. Postmenopausal women had significantly higher LH and FSH levels, and significantly lower E2, T, and E2/T levels. Postmenopausal women had significantly higher rates of insufficient colposcopy, transformation zone typeⅢ, positive cervical cytology, positive vaginal wall involvement, positive margin, pathological upgrading, HPV 16 positivity, and HSIL. Premenopausal women had a higher rate of normal cytology. No difference in other high-risk HPV types. Postmenopausal women were less likely to choose LEEP and more likely to choose cervical section, with a significantly higher postoperative recurrence rate. Conclusion Postmenopausal women show distinct differences from premenopausal women in terms of HPV infection types, colposcopic findings, and post-treatment recurrence. Long-term follow-up and intervention are essential for postmenopausal patients.更多还原