南方医科大学学报 ›› 2014, Vol. 34 ›› Issue (09): 1355-.

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妊娠期妇女宫颈筛查:附2329例报告

王莹,余艳红,肖琳,米贤军,符丽华,罗燕艳   

  • 出版日期:2014-09-20 发布日期:2014-09-20

Clinical analysis of cervical screening in 2329 pregnant women

  • Online:2014-09-20 Published:2014-09-20

摘要: 目的通过对2329例妊娠期妇女宫颈筛查及产后随访资料,探讨妊娠期宫颈细胞病理学特征、宫颈病变情况及产后的转
归,为宫颈癌防治提供依据。方法选择2012年09月~2013年09月在我院产检的孕妇共2329例行TCT检查,对异常结果者进
行随访、阴道镜检查及宫颈组织活检,并与同期进行的中山市宫颈癌大规模筛查项目的非孕期妇女共32491例的液基细胞学检
测(TCT)结果进行分析。结果孕期2329例TCT中细胞阳性病例97例,总检出率4.16%;97例TCT阳性孕妇有14例进行了活
检,活检率为14.43%,8例病理结果阳性(CINⅠ及以上),阳性率为57.14%;同期有32491例非孕期女性行TCT检查,其中TCT
异常人数为1383例,占4.26%,1383例TCT阳性非孕期女性有248例进行了活检,活检率为17.93%,148例病理结果阳性,阳性
率为59.68%。孕期与非孕期比较,总的细胞学阳性率间的差异无统计学意义(P=0.911),其中HSIL检出率非孕期高于孕期女
性,差异有统计学意义(P=0.033,P<0.05),但两组CIN发生率、宫颈癌发生率、活检率、病理阳性率之间的差异均无统计学意
义。孕期CIN组孕期定期检查及产后随访均未见浸润癌的发生。结论妊娠不是加速宫颈病变进展的危险因素,绝大多数宫颈病
变孕妇均于产后自行缓解或无进展,对孕期发现宫颈癌前病变除浸润性病变外的妇女可以进行随访观察及产后再评估的模式。

Abstract: Objective To study the cytopathologic characteristics of cervical diseases in pregnant women and the outcomes of
the postpartum women to provide evidence for prevention and treatment of cervical cancer. Methods This study was
conducted among 2329 pregnant women undergoing routine gestational examinations between September, 2012 and
September, 2013. The women with abnormal cytological findings by Thin-prep cytology test (TCT) were followed up and
colposcopy and cervical biopsy were performed. The TCT results of these women were compared with those of 32 491
non-pregnant women in Zhongshan Cervical Cancer Mass Screening Program. Results Of the 2329 pregnant women, a total of
97 patients had abnormal TCT results (4.16%). Cervical biopsy were performed for 14 patients (14.43%), and 8 (57.14%) of them
had evidence of cervical intraepithelial neoplasia (CIN) or cancer on biopsy. In the 32491 non-pregnant women in the mass
screening program, 1383 (4.26%) women had abnormal TCT results and cervical biopsy were performed for 248 patients
(17.93%), among whom 148 (59.68%) had evidence of CIN or cancer on biopsy. The rate of high-grade squamous intraepithelial
lesion (HSIL) was significantly higher in non-pregnant women than in pregnant women (P=0.033), but the total rate of
cytological abnormalities were comparable between them (P=0.911). The patients with CIN had regular examinations during
pregnancy and postpartum follow-up showed no invasive carcinoma. Conclusion Pregnancy is not a risk factor to accelerate
the progress of cervical lesions, and most of the cervical lesions are relieved or show no progression in the postpartum women,
suggesting the feasibility of follow-up during pregnancy and postpartum reevaluation for patients with CIN in pregnancy.