妊娠期宫颈上皮内瘤样病变的筛查及治疗

Screening and Management of Cervical Intraepithelial Neoplasia During Pregnancy

综述了妊娠期宫颈上皮内瘤样病变的筛查方法 ,强调保守性治疗 ,反复阴道镜检查及镜下活检是安全可靠的 ,追加醋酸白试验可增加过度诊断 ,但敏感性可大大提高。如果阴道镜检查排除宫颈浸润癌 ,妇产科医生可将治疗时间推迟至产后 ,母婴危险性将降低。LEEP(loopelectrosurgicalexcision)治疗及宫颈锥切只应有于病理或阴道镜检查高度可疑癌或已证实为癌症的孕妇。妊娠期CIN转归率较高 ,但必须严密随访。

There is high persistence rate of cervical intaepithelial neoplasia(CIN)in pregnancy.This paper reviews methods screening for CIN in pregnancy,and concludes that conservative management by repeated colposcopy and colposcopically directed biopsies is a safe and reliable method.Colposcopy excluding microinvasive or invasive carcinoma allow the gynecologist to defer definitive therapy to the postpartum period,when the fetal and maternal risks are obviously diminished.The addition of the acetic acid test(AAT)will overdiagnose to some extent,but the sensitivity will be significantly improved.Loop electrosurgical excision and cone biopsy of the cervix during pregnancy should be reserved for patients with evidence or suspicion of carcinoma by biopsy or colposcopy.CIN during pregnancy have a high progression,but we should ensure a high follow up.