深圳市子宫颈癌早诊早治初步研究

A priliminary study on early diagnosis and treatment for cervical cancer in shenzhen

目的研究深圳城市人群子宫颈癌早诊早治的适宜方式。方法2006～2007年采取整群随机抽样方法获得福田区教育局和龙岗区龙城街道紫薇社区样本人群及2005～2008年深圳市妇幼保健院妇科门诊机会性筛查人群。以上人群分别由学校工会和社区居委会、计划生育服务站宣教和组织;机会性筛查人群由妇科门诊护士和医师宣教和推荐。采用细胞学检查、HPV-DNA检测的筛查方法,异常者转诊阴道镜及病理诊断,病理诊断为金标准。采用筛查率、早诊率、早治率和行政费用率进行评价。结果2006年福田区教育局系统中小学教职工筛查率77.32%,紫薇社区人群筛查率18.56%,差异有统计学意义(x^2=3005.435,P=0.000);两组人群早诊率100%,治疗率均在90%以上。2005～2008年深圳市妇幼保健院子宫颈癌机会性筛查干预后有连续增长趋势(x^2=1588.5503,P=0.000)。2004～2008年子宫颈癌早诊率年平均89.85%,5年早诊率差异无统计学意义(x^2=6.513,P=0.164)。2006～2008年治疗率明显增高(x^2=123.090,P=0.000)。机会性筛查行政费用率明显低于组织性筛查(x^2=30.626,P=0.000)。结论城市人群子宫颈筛查以工作单位或社区居委会计划生育服务站组织为佳;机会性筛查可做为城市人群子宫颈癌组织性筛查的重要补充,门诊医师的宣教可提高机会性筛查率;城市人群子宫颈癌筛查宜提倡组织性筛查与机会性筛查相结合。

Objective To study the proper way of cervical cancer early diagnosis and early treatment for the urban population in Shenzhen. Methods In 2006-2007, the method of whole-population randomized-sampling procedure was adopted to obtain population-sample of the Education Bureau of Futian District and the population-sample of Ziwei Community in Longcheng Street of Longgang District, as well as Chance-Screening population in the gynecological out-patient de- partment of the Shenzhen Maternity ＆ Child Heahhcare Hospital in years from 2005-2008. All the above-mentioned populations were educated firstly and then organized respectively by trade unions of schools and the neighborhood committee of the communities as well as the family-planning service stations, The chance-screening populations received propaganda and education from and were recommended by OPD nurses and physicians in the Gynecology Department of the Institution.HPV-DNA was deteoted in the screening process; those showing abnormalities were transferred for further colposcopic and pathologic-section diagnosis with the latter being defined as the ‘golden criterion＇. Results Rate of screening among teachers and general staffs in primary and middle schools in the Education Bureau system of Futian District in 2006 was 77.32% while rate of screening in Ziwei Community population was 18.56% （X^2 = 3005.435, P = 0. 000）. Early diagnosis rate in both populations was 100% while with rate of treatment all showed above 90%. In years from 2005 - 2008, the average annual rate of chance-screening for cervical cancer in Maternity ＆ Child Heahheare Hospital revealed a tendency of a continuous increment after the interference （X^2 = 1588. 5503, P = 0. 000）. From 2004 -2008, annual average early diagnosis rate of uterine cervical cancer was 89.85% , with the 5-year early diagnosis rate was not significantly different, although 2006- 2008 showed a significant increase （X^2 = 123. 090, P = 0. 000）. The rate of administrative expenses of the process of chance-screening was significantly lower than that of organizational screening （ X^2 = 30. 626, P = 0. 000）. Conclusion Screening for cervical cancer in urban populations should organized by the working units or by the family-planning service stations of the community neighborhood committees. Chance-screening may be applied as an impor- tant supplementary procedure to organizational screening for cervical cancers in urban populations, while the propaganda and education offered by physicians in OPD may raise the chance-screening rate. It is also preferable to advocate a combination of both procedures of organizational and chance-screening for cervical diagnosis to be practiced in urban populations.