国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2015, Vol. 34 ›› Issue (6): 475-479.

• 讲座 • 上一篇    下一篇

HPV感染所致宫颈病变的诊断与治疗

谢锋，隋龙   

  1. 200011 上海，复旦大学附属妇产科医院宫颈疾病诊疗中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-11-15 发布日期:2015-11-15

Diagnosis and Treatment of Cervical Lesions Due to HPV Infection

XIE Feng，SUI Long   

  1. Medical Center for Diagnostics and Treatment of Cervical Diseases，Obstetrics and Gynecology Hospital of Fudan University，Shanghai 200011，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-11-15 Online:2015-11-15

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摘要： 人乳头状瘤病毒（HPV）感染所致宫颈病变的诊断主要依靠“三阶梯”流程，即细胞学和（或）HPV检查、阴道镜检查和组织学活检。目前可行的（过渡性）筛查方案为：21岁以下不作常规筛查，21～24岁液基细胞学初筛，25岁及以上者HPV分型（HPV16，18及其他12种高危亚型）初筛，非HPV16，18阳性者细胞学分流，65岁以上（无宫颈病变史）停止筛查。细胞学为高度鳞状上皮内病变（HSIL）病例可行“即诊即治”。HPV感染所致宫颈病变的治疗包括随访、切除性治疗和毁损性治疗。各种治疗方式各有利弊，没有一种治疗方法绝对优于其他方法。手术方法的选择必须基于病变残留、不良反应、经济成本和能否提供较阴道镜活检更足够、可靠的标本用于组织学检查以及患者年龄、生育要求综合考虑，权衡利弊，作出最合适的个体化方案选择。

关键词: 乳头状瘤病毒科, 感染, 宫颈上皮内瘤样病变, 诊断, 治疗

Abstract: The main strategy of diagnosis of cervical lesions caused by human papillomavirus（HPV） infection is the three-steps strategy, cytological test and/or HPV testing, colposcopy and histology. Currently, the feasible transitional screening program is as follows: no routine screening for women younger than 21 years, cytological preliminary screening for women between 21 and 24 years, HPV screening and typing for women older than 25 years and cytological test for those women with positive HPV excluding 16 and 18 types, and stop HPV screening for those women over 65 years and without the history of cervical lesions. The "See and Treat" should be taken for patients with the high-grade squmous intarepithelil lesions（HSIL） diagnosed by cytological test. The regular treatment for patients with cervical lesions caused by HPV infection includes follow-up, excision and ablation. There is not an absolute method, because there are advantages and disadvantages in each therapy. The most suitable selection of the individualized treatment should be based on the residue of lesion, side effect, economic cost, age and fertility desire, and offering more adequate and reliable sample for histological examination than colposcopy.

Key words: Papillomaviridae, Infection, Cervical intraepithelial neoplasia, Diagnosis, Therapy