妊娠期宫颈上皮内瘤变的监测及治疗

目的研究妊娠期宫颈上皮内瘤变（CIN）的转归,评估细胞学和阴道镜检查用于监测妊娠妇女CIN的安全性。方法对19例妊娠前通过细胞学和/或阴道镜检查诊断为CIN的妇女妊娠期间每3个月进行一次细胞学和阴道镜检查进行随访,并于产后两个月进行细胞学和阴道镜检查的再评估,必要时产后给予宫颈环形电切术（loop electrosurgical excisionp rocedure,LEEP）,如果怀疑微灶浸润,则给予局部活组织检查。结果 8例产前诊断为CINⅠ的妇女中有3例产后病变消退（37.5%）,10例产前诊断为CINⅡ～Ⅲ的妇女中有5例产后病变消退（50%）,有1例妇女发现可疑微管浸润,于妊娠期行局部活组织检查,为早期间质浸润（〈1mm）,无一例产前诊断为CINⅢ的病例产后发现微管浸润（1.5mm）。87.5%的消退病例和60%的病变稳定病例经阴道分娩（P=0.057）。结论经过妊娠有87.5%的CIN消退率,这可能归因于宫颈成熟和阴道分娩过程中发育不良宫颈上皮丢失所致,细胞学和阴道镜检查评估是安全的,局部小面积的活组织检查在可能发生的微管浸润时被推荐使用。

Monitoring and treatment of cervical intraepithelial neoplasia during pregnancy

Objective To investigate the evolution of cervical intraepithelial neoplasia（CIN）,and to evaluate the safety of cytological and colposcopical surveillance of women with CIN during pregnancy.Methods Nineteen women with antenatal cytological and/or colposcopical impression of CIN were followed up during pregnancy with cytology and colposcopy every 3 months.A cytological and colposcopical reevaluation 2 months postpartum was done,and loop electrosurgical excision procedure（LEEP） was performed if appropriate.Punch or loop biopsies were only taken if there was suspicion of microinvasion.Results In 3 of 8（37.5%） and in 5 of 10（50%） women with antenatalim pression of CINⅠ and CINⅡ~Ⅲ,respectively,there was postnatal impression of regression.one women with findings suspicious of microinvasion underwent small loop biopsies during pregnancy,and early stromal invasion（1mm） was seen.There was one more case of microinvasion（1.5mm） diagnosed postnatally in which the antenatal impression was of CINⅢ.87.5% of the women with regression compared to 60% of the women with stable disease had a vaginal delivery（P=0.057）.Conclusion There is a considerable regression rate of CIN after pregnancy possibly attributable to the loss of the dysplastic cervical epithelium during cervical ripening and vaginal delivery.Frequent cytological and colposcopical evaluation seems to be safe.Small loop biopsies are recommended in cases of possible microinvasion.