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目的:评价妊娠期妇女应用液基细胞学进行宫颈病变筛查的效果。方法:2008年3月~2010年12月对甘肃省人民医院产科门诊1 537例妊娠妇女进行宫颈病变筛查,采用液基薄层细胞学检查,以宫颈活检的组织病理学结果为确诊标准。对细胞学异常的孕妇进行孕期和产后随访。结果:1 537例妊娠妇女中,宫颈感染性疾病发生率为9.43%(145/1 537),液基细胞学检查细胞异常的发生率为1.23%(19/1537),对其中的15例进行了阴道镜检查并行宫颈活检,10例正常或慢性炎症,3例CINⅠ,1例CINⅢ,1例宫颈癌Ib2。对妊娠期4例CIN患者在孕期及产后半年进行复查,3例CINⅠ患者中2例自然消退,1例仍为CINⅠ,行宫颈激光治疗,另1例CINⅢ级别降低为CINⅡ,行宫颈电切除术,1例宫颈癌Ib2终止妊娠行化疗及手术治疗,随访无复发。结论:产前检查是进行宫颈病变筛查的良好时机,液基细胞学、阴道镜检查及宫颈活检是妊娠期宫颈病变筛查有效且安全的方法,对妊娠期细胞学异常的孕妇在确保无浸润癌的前提下主张孕期严密观察,产后酌情处理。
Objective: To evaluate the effect of liquid-based cytology for screening cervical lesions in pregnant women. Methods: From March 2008 to December 2010, 1 537 pregnant women in obstetric outpatient department of Gansu Provincial People’s Hospital were screened for cervical lesions by liquid-based thin-layer cytology. Histopathological findings of cervical biopsy were used as the diagnostic criteria. Pregnancy and postpartum follow-up of pregnant women with abnormal cytology. Results: Among 1,537 pregnant women, the incidence of cervical infection was 9.43% (145/1 537). The incidence of cervical cytology was 1.23% (19/1537), of which 15 Colposcopy and cervical biopsy parallel, 10 cases of normal or chronic inflammation, 3 cases of CIN Ⅰ, 1 case of CIN Ⅲ, 1 case of cervical cancer Ib2. During the pregnancy and 6 months after delivery, 4 cases of CIN during pregnancy were reviewed. 2 of 3 CIN Ⅰ patients subsided spontaneously, 1 remained CIN Ⅰ, treated with cervical laser, and the other 1 CIN Ⅱ reduced to CIN Ⅱ. Cervical resection , 1 case of cervical cancer Ib2 termination of pregnancy chemotherapy and surgical treatment, no recurrence. Conclusions: Prenatal examination is a good time to screen cervical lesions. Liquid-based cytology, colposcopy and cervical biopsy are effective and safe screening methods for cervical lesions during pregnancy. Under the premise of invasive cancer advocate strict observation during pregnancy, postnatal discretion.