宫颈液基细胞学检查在贵州黔南地区宫颈癌筛查中的临床运用

［摘要］目的　分析宫颈/阴道细胞学检查结果为未明确诊断意义的非典型鳞状细胞（atypical squamous of undermined significance，ASCUS） 或以上患者的组织病理，提高基层临床医生和病理医生诊断宫颈上皮内瘤变及早期宫颈癌的水平，预防宫颈浸润癌．方法　2014 年1 月 至2015 年6 月，贵州黔南地区在黔南州人民医院妇女宫颈癌筛查中，共检查4 579例．用 TBS 分类法（The bethesda system）报告宫颈/阴道液基细胞学检查结果为 ASCUS 或以上的病例164例，在阴道镜下取活组织进行病理检查．结果　164例中75例为宫颈上皮内瘤变二级（CINII）以上，占45.73%．39岁及以下者ASCUS 63例，CINII以上16例，占25.40%；40岁及以上者ASCUS 101例，CINII以上者59例，占58.41%．宫颈液基细胞学检查阳性的患者中，40岁以上患者风险更高．宫颈液基细胞学检查分为5级，Spearman等级相关分析，相关系数r＝1，呈完全正相关，P＜0.001，P＜0.01，差异有统计学意义，可认为宫颈液基细胞学检查级别越高，患宫颈癌的风险越大．结论　采用宫颈液基细胞学检查，有助于提高基层医生的宫颈上皮内瘤变（cervical intraepithelial neoplasia， CIN） 诊断率，有效预防普查所在地农村妇女宫颈浸润癌．

Clinical Analysis of Liquid-based Cervical Cytology Examination in Cervical Cancer Screening in the South of GuiZhou

［Abstract］Objectives　To enhance the diagnosis of cervical epithelial neoplasia and cervical cancer at the early stage and to prevent cervical invasive carcinoma by analyzing the cervical/vaginal cytology or histopathologic results of Atypical squamous cells of undetermined significance（ASCUS）. Methods From January 2014 to June 2015， a total of 4579 cases were selected in the census of gynecological diseases in Qiannan Hospital. TBS classification （the bethesda system） showed that 164 cases of ASCUS or above were found using cervical/vaginal cytology with live tissue under colposcopy．Results　Among 164 cases， 75 was cervical intraepithelial neoplasia level 3 （CINIII） accounting for 54.7%. Sixty-three cases of ASCUS and 16 of CINII or above were found among patients at the age of 39 or younger （25.4%）. A hundred and one cases of ASCUS and 59 of CINII or above were found among women older than 40 （58.41%）. Among patients with liquid-based cervical cytology positive， those older than 40 had higher risk. Liquid-based cervical cytology examination was divided into 5 levels. Spearman rank correlation analysis was applied with correlation coefficient （r = 1） and positive correlation was shown （P = 0.000， P＜0.01）. The difference was statistically significant. The higher level of liquid-based cervical cytology examination level was required， the higher risk of cervical cancer was seen among women. Conclusion　The use of liquid-based cervical cytology examination can help grassroots doctors improve CIN diagnosis rate and prevent cervical invasive carcinoma among women in the countryside.