北京市宫颈癌筛查宫颈细胞学机构事前质控评估方法及结果分析  

Practice of cervical cytology beforehand assessment and quality control of free cervical cancer screening in Beijing

作　　者：高丽丽[1] 沈洁[1] 张月[1] 韩历丽[1] GAO Li-li;SHEN Jie;ZHANG Yue;HAN Li-li(Beijing Obstetrics and Gynecology Hospital,Capital Medical University Belting Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院北京妇幼保健院妇女保健科,北京100026

出　　处：《中国临床医生杂志》2018年第11期1286-1290,共5页Chinese Journal For Clinicians

摘　　要：目的探索建立宫颈癌筛查宫颈细胞学机构事前质控评估方法 ,并用该方法对参与北京市宫颈癌免费筛查的宫颈细胞学检查机构进行事前质控评估,掌握机构服务现况及存在问题,筛选出宫颈细胞学产品、制片、阅片质量良好的机构,参与北京市宫颈癌免费筛查,提高筛查质量。方法采用资料审核、现场评价两种方法对影响细胞学检查质量的机构资质、硬件条件、制度、保存液质量、制片操作流程、人员能力等进行综合评价,筛选出宫颈细胞学产品、制片、阅片质量良好的机构。结果 16家机构参与了事前质控。通过专家组统一对资料进行审核剔除资料不全、字迹模糊、无相关资质、不符合技术要求的机构,最终6家机构5种产品进人现场评价阶段。保存液质量评估发现1家机构的产品不合格;2家机构的保存液取材后应在1周内尽快制片;2家机构的保存液可以4周内完成制片。现场评价基本具备承担筛查的硬件条件,但细胞学检查机构制度不健全,5家机构制订了质控方案,5家机构未对可疑病例进行追访;检查机构间人员的阅片能力有差异,人员阅片考核的平均分为64.6分;细胞学检查机构阅片质量复核符合率为95%,制片的操作流程欠规范。结论通过事前质控评估方法 ,筛选出了合格的细胞学检査机构及产品,要求各区从评估合格的机构中择优选择承担本区宫颈癌免费筛查中宫颈细胞学检测工作。同时通过评估发现宫颈细胞学检查机构管理及操作欠规范,阅片人员的技能需加强。下一步将针对存在问题,组织统一培训,规范服务流程,加强对筛选合格机构的日常监管和内部质控,不断提高筛查质量和技术水平。Objective To explore methodology of beforehand quality control on cervical cytology, and applied into cervical cancer screening to evaluate the services system which is helpful to select the suitable agencies for cervical cytology products, fihn production and diagnosis qualified for free cervical cancer screening in Beijing. Method Overview the qualifications, housing and equipment, regulations, quality of preservation solution, production process and personnel capacity which could affect the quality of cervical cytology by material review and site supervision, then select the qualified agencies. Result 16 agencies applied to participate in the quality control. Remove those with information missing, unrecognized writing, unqualified agencies, finally 6 agencies with 5 productions entered the next round. As for the preservation solution, one was unqualified; the other two should be prepared as soon as possible within one week, and still the other two should be prepared as soon as possible within four weeks. By site supervision, all of the housing and equipment were qualified for free cervical cancer screening. While the system was not perfect, 5 of them set up quality control plan but lack of the suspicious cases following-up. Diagnosis skills varies among agencies, average score was 64 of the staffs accepted evaluation. Coincidence rate of cytology diagnosis between experts and staffs was 95% , and the operating procedure of the film production was under-standardized. Conclusion By beforehand assessment, qualified cytology agencies and products were selected which could provide evidence for all districts in Beijing to carry on free cervical cancer screening. At the same time, we could also find that management, operation process and diagnosis skills need to be further improved. In the future, more emphasis will be put on staffs training, services processing, supervision and quality control to empower free cervical cancer screening in Beijing.

关 键 词：液基细胞学 宫颈癌 事前质控评估 质量控制 制片技术 

分 类 号：R173[医药卫生—妇幼卫生保健]