妊娠期女性宫颈细胞学异常的临床观察

Clinical Observation of Abnormal Cervical Cytology in Pregnant Women

目的观察并探讨妊娠期女性宫颈细胞学异常及产后转归,为临床诊治与管理提供依据。方法回顾性分析妊娠期自愿接受宫颈液基细胞学(TCT)筛查的孕妇共3610例,对其中318例TCT异常的孕妇,进行高危人乳头瘤病毒(HR-HPV)检测,可疑病变进行阴道镜检查、活检。分析妊娠期及产后TCT检查结果、HR-HPV的感染情况、阴道镜下活检病理结果。结果产后TCT阳性率较妊娠期明显下降(P<0.01),差异具有统计学意义;妊娠期HPV检测阳性率41.19%,产后36.11%,差异无统计学意义(P>0.05);活检病理产后于妊娠期比较,明显降级,差异具有统计学意义(P<0.01)。结论妊娠不会加速宫颈病变进展,宫颈细胞学异常产后大多数降级、自然消退率高,极少进展为浸润癌,妊娠期排除宫颈浸润癌后,严密监测下可推迟至产后治疗,并且需长期密切随访。

Objective To observe and discuss the abnormal cervical cytology in pregnant women and the clinical outcome after ginving birth,To provide basis for diagnosis treatment and management.Methods A total of 3610 pregnant women who voluntarily received TCT screening during pregnancy were retrospectively analyzed.Among them 318 pregnant women with abnormal TCT were tested for HR-HPV,Colposcopy and biopsy were performed for suspicious lesions.Analysis of pregnancy and postpartum TCT results,HR-HPV infection,biopsy pathological results.Results The positive rate of postpartum TCT was significantly lower than that of pregnancy(P<0.01),The difference was statistically significant.The positive rate of HPV detection in pregnancy was 41.19%and postpartum 36.11%,the difference was not statistically significant(P<0.05).The pathology of postpartum biopsy was significantly degraded compared with that of gestation,and the difference was statistically significant(P<0.01).Conclusion Pregnancy does not accelerate cervical progression,cervical cytology abnormal postpartum most of the downgrade,natural regression rate is high,rarely does it progress to invasive cancer.After exclusion of cervical infiltrating carcinoma during pregnancy,intensive monitoring may delay treatment until postpartum and long-term follow-up is required.