三阶梯技术在筛查妊娠期妇女宫颈病变的临床应用

目的探讨三阶梯技术在诊断孕妇宫颈病变的临床价值和安全性。方法采用队列研究方法，选择2008年1月1日至2011年12月31日在密云县妇幼保健院产科门诊初次检查的孕10—32周、1年内未进行过宫颈液基薄层细胞学检查（TCT）的6649例孕妇，先行TCT筛查，对TCT结果异常者在知情同意后进行阴道镜检查和阴道镜指引下宫颈多点活检。结果①TCT筛查6649例孕妇，其中TCT结果异常154倒，发生率为2．32％；②114例孕妇的阴遭镜图像满意度为93．86％（107／114），阴道镜拟诊慢性宫颈炎12例、鳞状上皮低度病变（LSIL）67例、鳞状上皮高度病变（HSIL）35例；③114例孕妇全部进行了宫颈活检，病理结果为宫颈炎及宫颈湿疣共48例，宫颈上皮内瘤样病变（CIN）136例、CINⅡ18例、CINⅢ10例、宫颈癌早浸2例；④与宫颈活检病理结果比较，阴道镜检查拟诊炎症和LSIL79例，其中71例与宫颈活检病理结果相同，符合率为89．87％（71／79），79例拟诊炎症和LSIL患者中，无鳞状细胞癌（SCC）病例。拟诊为HSIL的35例孕妇中，20例活检病理结果为CINⅡ或CINⅢ，2例为早浸，符合率为57．14％（20／35）；⑤未发生与阴道镜检查和宫颈活检相关的不良事件。结论对1年内未进行宫颈细胞学筛查的孕妇进行TCT检查是必要的，对TCT结果异常者应进行阴道镜检查，阴道镜检查拟诊宫颈炎或LSIL可以随诊；对阴道镜检查下拟诊高级别宫颈病变的孕妇，应行阴道镜下宫颈活检以明确病理学诊断。

Clinical application of three-step technology in screening cervical lesions among pregnant women

Objective To estimate the clinical value and safety of three-step technology in diagnosing cervical lesions associated with pregnancy. Methods Cohort study was adopted. Pregnant women with 10-32 weeks of gestation and not taking TCT within one year were selected from January 1, 2008 to December 31, 2011 when they took first examination at the out-patient clinic of Miyun County Maternal and Child Health Hospital of Beijing. TCT was performed firstly, and the cases with abnormal results accepted colposcopy examination and cervical multi-point biopsy under colposcope with informed consent. Results TCT screening was performed in 6 649 pregnant women, and 154 cases had abnormal TCT results with the abnormality rate of 2.32%. Colposcopy examination was performed in 114 cases, and the satisfaction degree of colposcopy image was 93.86% （107/114）. There were 12 cases diagnosed with chronic cervicitis, 67 cases with low-grade squamous intraepithelial lesion （LSIL） and 35 cases with high-grade squamous iutraepithelial lesion （HSIL） by colposcopy examination. All of 114 cases accepting colposcopy examination took cervical biopsy, and histopathology results indicated cervicitis and cervical condyloma in 48 cases, CIN Ⅰ in 36 cases, CIN Ⅱ in 18 cases, CINⅢ in 10 cases, and SCC stage Ⅰ in 2 cases. Comparison of colposcopy examination and cervical biopsy showed that the diagnosis of 71 of 79 cases by eolposcopy examination were in accordance with histopathology results, and the coincidence rate was 89.87% （71/79）. And in 79 cases with inflammation and LSIL, squamous cell carcinoma （SCC） was not found in any cases. Among 35 cases of HSIL diagnosed by colposcopy examination, 20 cases were CIN Ⅱ or CIN Ⅲ according to biopsy results, and 2 cases were early infiltration with coincidence rate of 57.14% （20/35）. No examination-related complications occurred during and after the procedure. Condusion It is necessary to conduct TCT in pregnant women who have not received the test within one year, and co