液基细胞学在妊娠期宫颈病变筛查中的应用

Liquid-based Cytology Test in Screening of Cervical Lesions in Pregnant Women

目的探讨妊娠期宫颈疾病的特点和液基细胞学检查(TCT)在妊娠期宫颈疾病筛查中的意义。方法选择在我院行产前检查的妊娠期妇女2152例(A组),同期因各种妇科疾病就诊的非妊娠期患者3 673例(B组),同期行妇科健康检查的正常人群中非妊娠期妇女4 980例(C组),采用液基细胞学方法进行宫颈疾病筛查。结果A组宫颈病变总发生率为17.98%(387/2152),B组为18.02%(662/3 673),C组为11.35%(565/4 980),研究组明显高于对照组(P<0.01)。研究组的宫颈感染性病变发生率为12.78%(275/2152),对照组为5.44%(271/4980),研究组明显高于对照组(P<0.01);研究组宫颈上皮细胞性病变检出率为5.20%(112/2152),对照组检出率为5.90%(294/4980),两组检出率差异无统计学意义(P>0.05);研究组2 152例中54例TCT检查后出血,均经局部压迫5 min左右出血停止,对照组中无出血情况发生;对妊娠期存在宫颈上皮性病变的妇女在产后进行再评估,12例LSIL和11例HSIL病变程度降低,15例LSIL和9例HSIL病变程度无进展。结论妊娠期妇女宫颈病变发生率明显高于非妊娠期妇女,液基细胞学检查用于妊娠期宫颈病变是必要、安全、有效的,妊娠期TCT异常者,产后应再次评估。

Objective To investigate the clinical significance of liquid based cytology thinprep cytologic test （TOT） in pregnant women and cytological characteristics of the smears during pregnancy. Methods TCT for screening cervical lesions was performed in 2,152 pregnant women who had normal prenatal examination （study group）, 3,673 non - pregnant women with gynecologic diseases （group B） and 4,980 non pregnant women who had normal gynecological examination （control group） at the same period in our hospital. Results The total incidence rates of cervical lesions and infection in the study group （17.98%, 12.78% ） were significantly higher than those in the control group （11.35%, S.44% ） （P〈0.01）. The detection rate of abnormal epithelial patterns was 5. ：20% in the study group and 5.90% in the control group. No statistically significant difference was found in the detection rate between the two groups （P〉0.05）. The rate of bleeding after TCT ex- amination in the study group was 2.51% （54/2,152）, but bleeding was controlled after compressing for 5 minutes. No bleed- ing was found in the control group. Among 47 cases diagnosed with cervical squamous intraepithelia lesions during pregnancy, 23 cases had milder disease and 24 cases demonstrated no further development after postnatal examination. Conclusions The incidence rate of cervical lesions in pregnant women is significantly higher than that in non- pregnant women. TCT performed in pregnant women for cervical lesions screening is necessary, safe and effective. During post - partum, repeating cervical smear in the pregnant women with abnormal cytology is necessary.