妊娠期生理特点与宫颈癌的关系及围妊娠期宫颈癌筛查的意义

Association between physiological characteristics during pregnancy and cervical cancer and the significance of cervical cancer screening

目的探讨妊娠期生理特点与宫颈癌的关系及加强宫颈疾病史妇女围妊娠期宫颈癌筛查的意义。方法选取2018年1月至2020年1月间陕西省西安医学院第二附属医院妇产科门诊建立档案并接受正规产前检查的22141例孕妇作为研究对象,根据是否处于妊娠期进行分组,妊娠期3328例,非妊娠期18813例。按照自愿原则,受检者接受液基细胞学检查(TCT),共计3328例。TCT异常者及发现宫颈病变的孕妇,在产后6周进行TCT复查。对选择同期接受宫颈癌筛查项目的非孕期妇女开展TCT检查结果分析。结果TCT检查结果显示,妊娠期和非妊娠期妇女细胞学阳性比组间比较,差异无统计学意义(P>0.05)。非妊娠组患者高度鳞状上皮内病变(HSIL)高于妊娠组,差异有统计学意义(P<0.05)。两组患者的不典型鳞状细胞(ASC-US)、低度上皮内病变(LSIL)、不典型鳞状细胞(ASC-H)、鳞状细胞癌(SCC)和不典型腺细胞(AGC)比较,差异无统计学意义(P>0.05)。两组患者宫颈组织学结果中,宫颈上皮内瘤样病变(CIN)及宫颈癌发生率、活检率和阳性率比较,差异无统计学意义(P>0.05)。随访134例细胞学异常的妊娠期妇女,细胞学转阴率为68.7%(92/134),阴道镜检查结果显示,炎症或人乳头瘤状病毒(HPV)感染6例,CINⅠ5例、CINⅡ3例,CINⅢ2例,没有浸润癌出现。结论多数妊娠合并宫颈病变患者在产后可自行缓解或无进展,预后效果良好。

Objective To explore the relationship between the physiological characteristics during pregnancy and cervical cancer and the significance of strengthening cervical cancer screening in women with a history of cervical disease.Methods From January 2018 to January 2020,22141 pregnant women who established files and received regular antenatal examinations were selected as research subjects at Second Affiliated Hospital of Xi’an Medical College.They were categorized into a pregnancy group(3328 women)and a non-pregnancy group(18813 women).A total of 3328 women underwent thin prep liquid-based cytology(TCT)examination based on the intention-to-treat principle.For those with abnormal TCT results and cervical lesions,a TCT review was performed at 6 weeks after delivery.Non-pregnant women who received cervical cancer screening were selected the in the same period and the TCT test results were analyzed.Results The results of TCT examination showed that there was no significant difference in positivity rate between the groups(P>0.05).In terms of high grade squamous intraepithelial lesion(HSIL),the nonpregnant group was significantly higher than the pregnant group(P<0.05).There were no significant differences in atypical squamous cells of undetermined significance(ASC-US),low-grade squamous intra-epithelial lesion(LSIL),atypical squamous cells:cannot exclude high-grade squamous intraepithelial lesion(ASC-H),squamous cell carcinoma(SCC)and atypical glandular cells(AGC)between the two groups(P>0.05).Cervical biopsy results showed that there was no significant difference in cervical intraepithelial neoplasia(CIN)and the incidence,biopsy rate and positivity rate of cervical cancer between the two groups(P>0.05).A total of 134 pregnant women with abnormal cytology were followed-up.The rate of cytological negative conversion was 68.7%(92/134).Colposcopy examination found that inflammation/Human papillomavirus(HPV)infection occurred in 6 patients,CIN Ⅰ occurred in 5 patients,CIN Ⅱ occurred in 3 patients and CIN Ⅲ occurred in 2 patients.Conclusion Most pregnant women with cervical lesions will recover spontaneously or no progress after delivery with good prognosis.