5296例妊娠和产后妇女宫颈细胞学筛查及随访

Cervical cytological screening and management in pregnant and postpartum women

目的:对妊娠和产后妇女行宫颈细胞学检查并随访,研究其宫颈细胞病理学特征,制订妊娠和产后妇女宫颈细胞学筛查计划,确定异常妇女的管理方案。方法:对5296例妊娠和产后妇女行宫颈细胞学检查,均采用2001年TBS诊断标准,对结果异常者随访至正常,对持续异常或升级者行进一步检查。结果:本组妊娠妇女细胞学筛查阳性462例(8.72%),对其中419例细胞病理学异常者成功随访。3个月总体转阴率为73.74%(309/419),其中不典型的鳞状上皮细胞(ASC-US)组79.56%,不除外高度鳞状上皮内病变的不典型的鳞状上皮细胞(ASC-H)组64.29%,不典型腺上皮细胞(AGC)组100%,低度鳞状上皮内病变(LSIL)组72.14%,高度鳞状上皮内病变(HSIL)组44.12%;转阴后持续6个月以上者72.32%(303/419);升级者1.43%(6/419)。46例行阴道镜下活检,细胞病理与组织病理总符合率63.04%。结论:应重视妊娠和产后妇女宫颈细胞学筛查工作,妊娠期和产后妇女宫颈细胞学形态具有独特性,易造成假阳性诊断。为避免漏诊真正的病变,必须密切随诊。可适当放宽阴道镜下活检指征。

Objective：To examine and follow up cervical cytology of pregnant and postpartum women and study their cytopathologic characteristics,and to manage the abnormal cervical cytological findings.Methods：A total of 5296 patients in pregnancy and postpartum were examined by pap smear and diagnosed with the Bethesda System（TBS） 2001.Those cytological abnormal patients were ibllowed up until the lesions regressed to normal. The remaining patients,who exhibited persistent abnormalities or progression,were given further check-up. Results：The positive rate of cervical cytological test was 8.72%（462/5296）.A total of 419 cytological abnormal cases were followed up successfully.The total transnegative rate in 3 months was 73.74%（309/419）,in which 303 cases （72.32%） persisted normal status for more than six months after regression.Forty-six cases obtained biopsies through colposeopy.The coincidence of cytopathologie and histopathologic diagnosis was 63.04% （29/46）.Conclusion：We should pay more attention to screening of cervix lesions in pregnant and postpartum women.Their cytopathologic characteristics were liable to direct the clinician made a false positive diagnosis. We propose to follow up them closely and to expand the indication of biopsy.