【摘要】 目的调查我国目前省市级各类大医院开展子宫颈癌机会性筛查的基本现状,为我国探索城市地区子宫颈癌的防治策略提供依据。方法按照时间(2005～2007年)和医院类型(综合医院、肿瘤医院和妇幼保健院)分层分析全国不同地区14家医院子宫颈病变的筛查、诊断和治疗情况。结果在目前常用的筛查方法中,巴氏涂片所占比例为65.28%、液基细胞学检查占21.14%、HPV检测占6.84%、液基细胞学+HPV检测占1.39%、巴氏涂片+HPV检测占2.55%、肉眼检查占2.80%。但在2005～2007年期间,可以看出巴氏涂片所占比例均逐年降低(76.34%,68.98%,55.56%,x~2=29517.43,P<0.0001),而液基细胞学呈逐年增加的趋势(8.23%,15.16%,32.72%,x~2=64438.34,P<0.0001)。妇幼保健院采用巴氏涂片的比例(68.98%)要高于综合医院(54.49%)和肿瘤医院(41.13%)。液基细胞学在综合医院、肿瘤医院和妇幼保健院所占的比例分别为41.77%、12.86%和15.16%。在诊断的子宫颈病变中,浸润癌、原位癌/CIN 3、CIN 2和CIN 1的比例分别为28.14%、22.02%、21.95%和27.89%。浸润癌在肿瘤医院所占比例(59.59%)最高,癌前病变(CIN 3、CIN 2、CIN 1)在综合医院和妇幼保健院所占比例较高。治疗方式中LEEP所占比例(37.60%)最高,其在综合医院比例最高(56.19%),其次是妇幼保健院(36.96%),放化疗方式主要见于肿瘤医院(38.86%)。结论在我国城市的各类大医院中主要以细胞学为子宫颈病变的检测手段,液基细胞学正逐渐被广泛使用,作为一种新技术,HPV检测仍是我国城市妇女筛查的辅助手段。加强宣传、提高医院子宫颈癌机会性筛查的覆盖率、规范宫颈病变的早诊早治技术,是推动城市子宫颈癌防治的有效途径。更多还原

【Abstract】 Objective To investigate the cervical cancer opportunistic screening status in different provincial level and different types of hospitals in China,and provide the basis for cervical cancer screening strategy in urban areas in China. Methods The information of screening,diagnosis,and treatment of cervical lesions from 14 provincial level hospitals were analyzed by time strata(2005～2007) and by types(general hospitals,cancer hospitals and women and children’s hospitals).Results The proportions of conventional pap smear(Pap),liquid based cytology(LBC),HPV testing,LBC+HPV testing,Pap+HPV testing,and visual inspection were 65.28%,21.14%,6.84%,1.39%, 2.55%,and 2.80%respectively in current regular screening methods.The proportion of Pap smear was decreasing (76.34%,68.98%,55.56%,x~2=29517.43,P<0.0001) by years during 2005～2007,and on the opposite, LBC was increasing(8.23%,15.16%,32.72%,x~2=64438.34,P<0.0001).The proportion of Pap smear (68.98%) was higher in the women and children’s hospitals than those of general hospitals(54.49%) and cancer hospitals (41.13%).The proportion of LBC in the general hospitals,cancer hospitals and women and children’s hospitals were 41.77%,12.86%,and 15.16%,respectively.Invasive cervical cancer,cancer in situ/CIN 3,CIN 2 and CIN 1 were accounted for 28.14%,22.02%,21.95%,and 27.89%in the diagnosed cervical lesions.The proportion of invasive cervical cancer was the highest in cancer hospitals(59.59%),the proportion of pre-cancers(CIN 3,CIN 2, CIN 1) was higher in the general hospitals and women and children’s hospitals than the cancer hospitals.LEEP,cone knife excision,surgery,radio-chemotherapy,and surgery+radio-chemotherapy accounted for 37.60%,14.46%, 13.92%,20.46%,and 9.24%,respectively in the current therapy methods.LEEP was used more often in the general hospitals(56.19%) and women and children’s hospitals(36.96%),while the radio-chemotherapy was more commonly used in cancer hospitals(38.86%).Conclusion With the cytology beiny the major screening method for cervical cancer screening in the metropolitan hospitals,LBC is becoming more popular.HPV testing is the ancillary method as a new method.Education,increased coverage of opportunistic screening,and enhanced management of early diagnosis and treatment are the effective strategies to promote the cervical cancer prevention and control in the urban areas in China.更多还原