醋酸碘染色肉眼观察在农村组织性宫颈癌筛查中的应用探讨

Exploration on the application of visual inspection after acetic acid and iodine staining in screening of cervical carcinoma among rural women

目的：评价醋酸、碘染色肉眼观察在农村地区组织性宫颈癌筛查中的应用价值及可行性。方法：20062009年在子宫颈癌高发区江西省靖安县、铜鼓县对年龄为3059岁农村已婚妇女进行以人群研究为基础的,一年一次为期两年的醋酸、碘染色肉眼观察宫颈癌筛查。任何一项存在阳性进行阴道镜检查,必要时行宫颈组织活检,或行颈管刮术。以宫颈组织病理诊断为金标准。对检查结果进行分析。结果：以＂三级机构组合分工＂的方式进行普查。连续进行子宫颈癌筛查的靖安县筛查人群顺应性为69.0%,且未发现宫颈癌患者。铜鼓县筛查人群顺应性为54.0%,宫颈癌检出率略低于已往当地普查结果,但差异无统计学意义（P〉0.05）;宫颈癌前病变检出率高于以往普查结果。两县初筛检出率为C INⅠ572/10万（53例）,C INⅡ194/10万（18例）,C INⅢ302/10万（28例）,子宫颈癌22/10万（2例）。同一人群复查的检出率为C INⅠ92/10万（6例）,C INⅡ62/10万（4例）,C INⅢ77/10万（5例）,子宫颈癌0。结论：醋酸肉眼观察、碘染色肉眼观察方便、廉价、易掌握,易被人群接受,初查时可较好地发现宫颈癌及癌前病变患者,不易漏查宫颈癌患者,适宜在农村宫颈癌高发区推广应用。宫颈癌筛查应持续。

Objective：To evaluate the application value and feasibility of visual inspection after acetic acid and iodine staining in screening of cervical carcinoma among rural women.Methods：The rural married women aged 30～59 years old from Jing’an county and Tonggu county in Jiangxi province from 2006 to 2009 received screening of cervical carcinoma by visual inspection after acetic acid and iodine staining based on population study once a year for two years,the women with positive results received colposcopy,cervical biopsy or diagnostic curettage if necessary,pathological diagnosis was gold standard,the results were analyzed.Results：The mode of combination and division of three grades institutions was used for screening,the compliance of continuous screening population of cervical carcinoma in Jing’an county was 69.0%,no patients with cervical carcinoma was found;the compliance of continuous screening population in Tonggu county was 54.0%,the detection rate of cervical carcinoma was lower than local screening results in previous years,but there was no significant difference（P〉0.05）;the detection rate of cervical carcinoma was higher than local screening results in previous years;the detection rates of CIN I,CIN Ⅱ,CIN Ⅲ and cervical carcinoma during primary screening in the two counties were 572/100 000（53 cases）,194/100 000（18 cases）,302/100 000（28 cases） and 22/100 000（2 cases）,respectively;the detection rates of CIN I,CIN Ⅱ,CIN Ⅲ and cervical carcinoma during secondary screening of the same population in the two counties were 92/100 000（6 cases）,62/100 000（4 cases）,77/100 000（5 cases） and 0,respectively.Conclusion：Visual inspection after acetic acid and iodine staining is convenient,inexpensive,easy to handle and easily to be accepted by people,visual inspection can find the patients with cervical carcinoma and precancerous lesion during primary screening,and missed diagnosis of cervical carcinoma is infrequent,which is worth popularizing in high incidence area of cervical carcinoma;the screening of cervical carcinoma should be persistent.