农村地区醋酸/碘染色法筛查子宫颈癌的3年结果分析  

Three-year follow-up results of visual inspection with acetic acid/Lugol's iodine (VIA/VILI) used as an alternative screening method for cervical cancer in rural areas

作　　者：张永贞[1] 马俊飞 赵方辉[3] 向喜娥 马朝辉[1] 石樱桃[1] 胡尚英[3] 乔友林[3] 

机构地区：[1]山西省肿瘤研究所流行病室,山西太原030013 [2]山西省襄垣县妇幼保健院,山西长治046200 [3]中国医学科学院北京协和医学院肿瘤研究所流行病学研究室,北京100021

出　　处：《癌症》2010年第1期4-8,共5页Chinese Journal of Cancer

基　　金：中国癌症基金会示范基地项目资金(编号002);卫生部疾病控制局中央财政转移支付项目资金~~

摘　　要：背景与目的:我国至今还没有一个系统的子宫颈癌防治计划,尤其是广大农村地区更缺乏子宫颈癌的防治技术和经验。本研究报道山西省襄垣县子宫颈癌早诊早治示范基地的人群筛查资料,评价基层医生采用醋酸或碘染色法(VIA/VILI)在农村地区筛查子宫颈癌及其癌前病变的效果。方法:采用醋酸染色法(VIA)和碘染色法(VILI)在山西省襄垣县30～59岁的妇女人群中开展子宫颈癌筛查,VIA或VILI阳性者进行阴道镜检查,阴道镜检异常者在病变处取活检进行病理学诊断。采用同样的程序对人群进行复查,通过比较1年筛查、连续2年筛查和连续3年筛查的结果,评价该方案的筛查效果。结果:在2005～2008年期间,有7145名适龄妇女参加了筛查,平均年龄为42.16岁,筛查人群平均参与率为74.75%。其中2005～2007年期间,对1287人连续筛查了3年,第1轮筛查CIN2、CIN3及子宫颈癌的检出率分别为0.70%(9例)、1.01%(13例)、0.23%(3例);第2轮(976人)筛查检出率分别为0.22%(2例)、0.11%(1例)、0;第3轮筛查仅增加了1例CIN2病例。2006～2007年期间对3490人连续筛查了2年,第1轮(3490人)与第2轮(2943人)筛查CIN2、CIN3及子宫颈癌的检出率分别为0.26%(9例)、0.52%(18例)、0.15%(5例)和0.40%(14例)、0.40%(14例)、0.03%(1例)。同样2007～2008年期间对2368例人群连续筛查了2年,第1轮(2368人)与第2轮(2040人)筛查对于CIN2、CIN3及子宫颈癌的检出率分别为0.55%(13例)、0.25%(6例)、0.12%(3例)和0.42%(10例)、0.04%(1例)、0。2005～2008年期间筛查全部人群(7145)的CIN2、CIN3和子宫颈癌的累计检出率分别为0.81%(58例)、0.74%(53例)和0.17%(12例),其中53.45%(31例)的CIN2、69.81%(37例)的CIN3和91.67%的子宫颈癌(11例)是通过初次筛查发现的,除了第2轮筛查发现的1例早期癌(Ⅰa)。在查出的宫颈早期病变中,CIN1、CIN2、CIN3和子宫颈癌患者平均年龄分别为38.65岁、40.61岁、44.10岁、46.73岁。结论Background and Objective：In China,there is not an established national program for prevention and treatment of cervical cancer,and the screening methods and experiences are especially lack in the rural areas.This study was to evaluate the effect of visual inspection with acetic acid /Lugol＇s iodine （VIA /VILI） used as an alternative cervical cancer screening method in the rural areas in China by analyzing the large-scale populationbased screening data from the demonstration site.Methods：Women aged 30-59 years from Xiangyuan County in Shanxi Province were recruited for Cervical cancer screening from 2005 to 2007.VIA /VILI was the primary screening method followed by colposcopy if the VIA /VILI result was positive.cervical lesions were diagnosed by directed biopsy under the colposcopy.The women with VIA/VILI negative or cervical intraepithelial neoplasia （CIN） 1 were re-screened using the same procedure in the next year.The screening effect was evaluated by comparing the screening results.Results：Of 9558 women involved,7145 （74.75%）,with mean age of 42.16 years,received the cervical cancer screening.A total of 1287 women were consecutively screened for three times during 2005-2007.The detection rates of CIN 2,CIN 3,and cervical cancer were 0.70% （9 /1287）,1.01% （13 /1287）,and 0.23% （3 /1287） in the first round screening,and 0.22% （2 /976）,0.11% （1 /976）,and 0% （0 /976） in the second round screening,respectively.Only one CIN 2 was found in the third round screening.During 2006-2007,3490 women were screened consecutively twice;the detection rates of CIN 2,CIN 3,and cervical cancer were 0.26% （9 /3490）,0.52% （18 /3490）,and 0.15% （5 /3490） in the first round screening,and 0.40% （14 /2943）,0.40% （14 /2943）,and 0.03% （1 /2943） for the second round screening,respectively.Likewise,2368 women were screened consecutively twice during 2007 2008 ;the detection rates of CIN 2,CIN 3,and cervical cancer were 0.55% （13 /2368）,0.25% （6 /2368）,and 0.12% （3

关 键 词：子宫颈癌 醋酸染色法 碘染色法 筛查 农村 

分 类 号：R737.33[医药卫生—肿瘤]