国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2012, Vol. 31 ›› Issue (4): 273-275.

• 论著 • 上一篇    下一篇

宫颈癌筛查三阶梯技术临床应用探讨

陈洁清, 张映辉   

  1. 广东省佛山市禅城区中心医院妇产科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2012-07-15 发布日期:2012-07-15

Clinical Application of Three Steps Screening for Cervical Cancer

CHEN Jie-qing，ZHANG Ying-hui   

  1. Chancheng Central Hospital of Foshan，Foshan，Guangdong Province 528031，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2012-07-15 Online:2012-07-15

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摘要： 目的：探讨宫颈薄层液基细胞学（TCT）与高危型人乳头瘤病毒（HR-HPV） DNA检测，配合阴道镜检查下宫颈病理活检在宫颈癌筛查中的应用价值。方法：回顾分析2009年1月—2011年12月按照宫颈癌三阶梯检查方案接受宫颈癌筛查的8 199例女性个体筛查情况。结果：8 199例患者的TCT阳性检出率为6.6%（541/8 199），其中≥高度鳞状上皮内病变（HSIL）阳性检出率为1.56%（128/8 199）。1 258例接受HR-HPV DNA检测中HR-HPV感染率为55.96%。783例接受阴道镜检查的患者异常检出率为56.32%（441/783），异常者接受宫颈活检，占全部筛查者的5.38%（441/8 199）。宫颈癌及癌前病变检出率为51.93%（229/441），高度上皮内瘤变（≥CIN Ⅱ）检出率为25.4%（112/441）。随着宫颈病理学诊断的级别升高，HR-HPV DNA和TCT均阳性的检出率在CINⅠ、CINⅡ、CINⅢ、宫颈癌分别为54.70%、86.49%、96.43%和97.87%，CINⅢ、宫颈癌高于CINⅠ，差异有统计学意义（P＜0.01）。结论：采用TCT结合HR-HPV DNA检测，配合阴道镜检查下宫颈病理活检可以有效地检出宫颈病变，提高宫颈癌的筛查效果。

关键词: 宫颈肿瘤, 多相筛查, 细胞学技术, 阴道镜检查, 人乳头瘤病毒, 活组织检查

Abstract: Objective： To evaluate the clinical application of three steps screening for cervical cancer, being thinprep cytology test （TCT），high-risk human papilloma virus （HR-HPV） DNA，and colposcopy biopsy for pathological examination. Methods：The screening results of 8 199 women who received cervical cancer screening at Chanchcheng Central Hospital of Foshan，from January 2009 to December 2011，with the three steps screening program，were analyzed retrospectively. Results：The positive rate of TCT was 6.6%，and the positive rate of ≥HSIL was 1.56%，in 8 199 participants. The infection rate of HR-HPV was 55.96% in 1 258 participants. 783 participants received colposcopy，and the positive rate was 56.32%. 441 patients underwent cervical biopsy，the biopsy rate was 5.38%. In pathological examination，the positive rate of precancer was 51.93%，the detection rate of high-grade cervical intraepithelial neoplasia was 25.4%. According to pathological grades，the detection rates were：CINⅠ54.70%，CINⅡ86.49%， CINⅢ96.43%，cervical cancer 97.87%. The detection rates of CINⅠand cervical cancer were higher than that of CINⅢ，while the double positive rate of TCT and HR-HPV DNA of cervical cancer was statistically higher than those of CINⅠ，CINⅡ and CINⅢ （P＜0.01）. Conclusions： Three steps screening，TCT combining with HR-HPV DNA detection and colposcopy in cervical biopsy for pathology，can effectively detect cervical lesions and improve screening rate of cervical cancer.

Key words: Uterine cervical neoplasms, Multiphasic screening, Cytological techniques, Colposcopy, Human papillomavirus, Biopsy