龙川县1620例宫颈癌机会性筛查结果分析

Results Analysis of Uterine Cervical Cancer Screening in 1 620 Cases from Longchuan County

目的研究龙川县妇女宫颈癌及癌前病变的现状，探讨液基细胞学检查（TCT）及阴道镜等在宫颈癌诊断的临床意义及应用价值。方法收集分析2008年1月-2013年6月妇科门诊进行宫颈癌机会性筛查的1620例，根据就诊类型分为观察组（各机关事业单位及部分企业计划定期普查发现宫颈癌前病变及宫颈癌患者，480例）和对照组（随机抽查同期来我院就诊发现宫颈癌前病变及宫颈癌患者，1140例）。对TCT阳性者进行阴道镜下宫颈活检及病理检查，确诊宫颈病变及宫颈癌。结果1620例受检者中，TCT阳性258例（占15.9%），活检证实为宫颈上皮内瘤变（CIN）者64例（占3.95%）、宫颈浸润癌2例（占0.12%）。在TCT阳性（258例）病例中，阴道镜检出异常者130例（占50.4%），其中活检结果为湿疣17例、CIN或浸润癌72例，阴道镜与活检诊断符合率为68.4%（89/130）。此外，不同年龄组对比发现，宫颈癌发病率差异有统计学意义（P＜0.05）；观察组和对照组阳性检出率差异有统计学意义（P＜0.05）。结论宫颈癌前病变及早期宫颈癌高发年龄为30～49岁，TCT结合阴道镜检查是较好的宫颈癌筛查手段之一。加大宣传力度，提高山区医师培训质量和增加经济投入，广泛开展宫颈癌前病变筛查工作，能显著降低宫颈癌的发生和发展几率。

Objectives To understand the morbidity status of uterine cervix cancer （UCC） and precancerous lesions of women in Longchuan County and evaluate the clinical application of thinprep cytologic test （TCT） and vaginoscopy in cervical cancer screening. Methods From 2008 Jan to 2013 Jun, the cervical cancer screening were carried out in 1 620 women of Longchuan County. If the result of exfoliated cells examination was suspicious or abnormal, vaginoscopy should be done. Results Among all 1 620 screened cases, the TCT was positive in 258 cases （15.9%）, which was conifrmed by biopsy of cervical intraepithelial neoplasia （CIN） 64 cases （3.95%）, cervical carcinoma in 2 cases （0.12%）. In 258 cases of TCT positive patients, 130 cases of abnormal colposcopy （50.4%）, 17 cases of condyloma, 72 cases of CIN or cervical carcinoma was conifrmed. The consistent rate of colposcopy and biopsy diagnostic was 68.4%（89/130）. There was signiifcantly difference for incidence rates of UCC among different age groups. Furthermore, the positive rate of the experiment group （women from enterprises, institutions, government organs and people’s organizations） was signiifcantly （P〈0.05） lower than that of control group （women from random screening）. Conclusions The incidence of UCC in age of 30～49 was greater than other age groups. TCT combination of colposcopy is a better means of screening for cervical cancer. Improve the quality of physician training and increase economic investment can decrease the incidence of UCC in undeveloped areas.