适宜农村地区子宫颈癌筛查方法的研究

Study on cervical cancer screening methods in low resource areas

目的探索适合宫颈癌高发且经济欠发达地区子宫颈癌及其癌前病变的筛查方法,以最终降低子宫颈癌的发病率和死亡率。方法以山西省襄垣县下良乡35￣55岁的妇女作为对象,进行以人群为基础的宫颈癌筛查。对符合条件的妇女进行危险因素、癌症及子宫颈癌认知情况的问卷调查,用醋酸染色后肉眼观察(VIA)和碘染色后肉眼观察(VILI)进行宫颈检查,结果异常者进行阴道镜下活组织检查并得到最终的病理学诊断。将该次筛查对不同级别病变的检出率与历年来的襄垣地区的筛查结果进行比较。结果该次筛查人群参与率为74.8%。患宫颈糜烂和滴虫感染的妇女分别占受检人群的48.3%和14.8%。最终经活检病理确诊的CINⅠ的现患率为0.8%(10例)、CINⅡ0.7%(9例)、CINⅢ1.1%(13例)、子宫颈癌0.2%(3例)。该次单纯肉眼观察对CINⅡ和对≥CINⅢ病变的检出率略低于已往当地普查项目,但差别无统计学意义。结论在资源有限,经济不发达的农村地区,由经过培训的医生进行肉眼观察的宫颈癌筛查是可行的,单纯肉眼观察是一种经济有效的筛查方法,建议进一步在农村地区进行推广。

Objective To explore appropriate screening methods for cervical cancer as well as precancerous lesions in low resource areas and to reduce incidence rate and mortality of cervical cancer eventually. Methods In Xialiang Commune, Xiangyuan County, Shanxi Province, cervical cancer screening was done in women aged between 35-55. After consented and investigated using questionnaire （including risk factors of cervical cancer, knowledge of cancers）, eligible women were examined by VIA and VILI and women who had abnormal results have received colposcopy directed biopsy .To Compare the detectable rate of this screening with former screenings in year 2001 and 2003 in Xiangyuan County. Results Attendance rate was 74,8%, the prevalence rates of cervical erosion and trichomoniasis are 48.3 % and 14.8 %. 10 （0.8%）women had biopsy-proven CIN Ⅰ, 9（0.7%）had CIN Ⅱ, 13（1.1%）had CIN Ⅲ and 3（0.2%） had cervical cancer. The detectable rates on CINⅡ as well as ≥ CINⅢ of visual inspection （including VIA and VILI） were lower than those in the former years, but there are not statistically significant. Conclusion Visual inspection done by well trained health care workers is a feasible screening method especially in the undeveloped rural areas. Visual inspection （VIA and VILI） is an economic-effective screening method that recommended to use and extend in rural areas.