妊娠期宫颈筛查异常的管理及妊娠结局  

The management and outcome of cervical lesions during pregnancy

作　　者：陈升平[1] 于莎莎[1] 李莹[1] 张蕊[1] 王香平[2] 杨咏梅[2] 王凤英[2] 

机构地区：[1]首都医科大学北京世纪坛医院产科,100038 [2]首都医科大学宣武医院

出　　处：《中国妇产科临床杂志》2012年第1期11-14,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：2006年首都医科大学基础临床课题基金(2006JL11)

摘　　要：目的选用3种筛查方式:高危型HPV、HPV联合TCT和TCT对妊娠期宫颈病变患者的管理及妊娠结局的研究。方法对在首都医科大学宣武医院产科就诊的3300例孕妇。随机分成三组,TCT组,TCT+HPV组和HPV组,每组1100例。HPV采用杂交捕获法检测。比较:宫颈病变的发生率、病理检查的阳性率、分娩方式的影响及产后的转归情况。结果①发病率:TCT组宫颈病变103例;TCT+HPV组中HPV阳性的323例宫颈病变106例,其中合并HPV阳性的91例;HPV组HPV阳性的310例;②病理检查:ASCUS、ASC-H和LSIL孕期不作进一步检查。TCT组9例经阴道镜检查有7例异常;TCT+HPV组10例经阴道镜检查有8异常;HPV组阳性者未行阴道镜检查;③产后复查:TCT组宫颈病变者103例,产后42d复查TCT24例异常,未治疗,产后3个月继续复查有9例异常,行阴道镜检查1例异常;TCT+HPV组宫颈病变者106例,产后42d复查TCT23例异常,未治疗,产后3个月继续复查有10例异常,阴道镜检查有2例异常,HPV阳性者323例,产后3个月复查HPV阳性6例;HPV组有HPV阳性者310例,产后42d31例阳性,产后6个月复查HPV阳性者9例。结论本研究表明妊娠合并宫颈上皮内瘤样病变者产后病变的自然缓解很高,HPV阳性者产后转阴性率为90.6%～98.1%。不影响妊娠结局。Objective To investigate the methods of cervical lesions during pregnancy and to analyze their pregnancy outcome.Methods 3 300 cases of pregnant women were randomly divided into three groups：TCT group,HPV group and TCT ＋ HPV group,with 1 100 patients in each group.The incidence of cervical lesions,the positive rate of pathological examination,the mode of delivery and post partum outcome were compared among the three groups.Results ① The abnormal cases in each goup：there were 103 cases in TCT group,106 cases in TCT ＋ HPV group and in HPV group,there were totally 310 cases positive.② Pathologic examination：Patients with ASCUS,ASC-H,LSIL and HPV-DNA positive didn＇t underwent further examination during pregnancy.In TCT group,there were 9 cases with abnormal colposcopy finding and 7 of them were confirmed by pathology;In TCT ＋ HPV group,10 patients with abnormal colposcopy results and 8 were pathological abnormal.③ Postpartum Review：The 103 cases of abnormal TCT results in TCT group turned to 24 cases on 42 days postpartum and 9cases on 3 months postpartum examination.1 cases were confirmed with CIN by colopscopy.In TCT ＋ HPV group,23 cases still with abnormal results on 42-day review and 10 of them consisted until 3 months＇ review.2 cases with abnormal colposcopy finding.Most of those 310 HPV-DNA positive patients turn to negative and only 31 were still positive in 42 days review and it dropped to 9 after 3 months.Conclusions This study shows that cervical intraepithelial neoplasia during pregnancy could regress to normal postpartum,and had no bad effect on pregnancy outcome.

关 键 词：高危型HPV检测 TCT细胞学检查 阴道镜检查 子宫颈上皮内瘤变 结局 

分 类 号：R737.33[医药卫生—肿瘤]