妊娠期宫颈癌TCT+HPV联合筛查及病变处理的临床研究  

Clinical study of TCT+HPV combined screening and lesion management for perinatal cervical cancer

作　　者：吴云燕 秦燕君 WU Yunyan;QIN Yanjun(Authors'address:Department of Obstetrics and Gynecology,Fuyang District Maternal and Child Health Hospital,Hangzhou 311400,China)

机构地区：[1]杭州市富阳区妇幼保健院妇产科,311400

出　　处：《浙江医学》2024年第15期1640-1642,1645,共4页Zhejiang Medical Journal

基　　金：浙江省卫生健康科技计划项目(2022KY1067)。

摘　　要：目的评估妊娠期妇女宫颈癌宫颈液基细胞学检查(TCT)+HPV联合筛查的安全性、必要性和有效性,以期为妊娠期宫颈病变处理提供参考。方法回顾性选取2021年8月至2023年4月在杭州市富阳区妇幼保健院妇产科就诊的3120例孕12~20周孕妇为研究对象,均进行TCT+高危型HPV联合筛查,根据筛查结果对部分病例进行阴道镜检查及产后42 d随访。结果3120例孕妇在孕期进行TCT+HPV联合筛查结果异常的有132例,TCT异常74例(2.37%),HPV16/18阳性87例(2.79%),其中未见恶性细胞和上皮内病变细胞(NILM)+HPV16/18阳性58例(1.86%),意义不明确的非典型鳞状上皮细胞(ASC-US)+HPV16/18阴性6例(0.19%),ASC-US+HPV16/18阳性9例(0.29%),鳞状上皮内低度病变(LSIL)+HPV16/18阴性27例(0.87%),LSIL+HPV16/18阳性13例(0.42%),意义不明确的非典型鳞状上皮细胞不除外高度鳞状上皮内病变(ASC-H)或鳞状上皮内高度病变(HSIL)+HPV16/18阴性12例(0.38%),ASC-H或HSIL+HPV16/18阳性7例(0.22%)。对13例LSIL+HPV16/18阳性、12例ASC-H或HSIL+HPV16/18阴性及7例ASC-H或HSIL+HPV16/18阳性,共32例孕妇在孕期进行阴道镜检查,病理报告显示无宫颈浸润癌,正常或炎症10例,宫颈上皮内瘤变(CIN)1级15例,CIN 2级5例,CIN 3级2例。孕期检查异常的132例孕妇产后42 d以后再次进行TCT+HPV及阴道镜检查,TCT+HPV检查异常的60例,TCT异常34例,HPV异常36例;产后阴道镜检查均无宫颈浸润癌,正常或炎症104例,CIN1级24例,CIN2级3例,CIN3级1例。结论妊娠期宫颈癌TCT+HPV联合筛查是安全的,方法与普通妇女筛查相同,孕期发现的宫颈癌前病变,可保守随访观察至产后再次评估治疗。妊娠不会加重宫颈癌前病变,大多数妊娠期宫颈病变产后可自行缓解。Objective To evaluate the safety,necessity,and efficacy of combining thinprep cytologic test(TCT)with high-risk human papillomavirus(HPV)screening in pregnant women,and to provide a reference for managing cervical lesions during pregnancy.Methods A retrospective study was conducted with 3,120 pregnant women,who were between 12 and 20 weeks of gestation,attending the obstetrics and gynecology department of Hangzhou Fuyang Women And Children Hospital from August 2021 to April 2023.All participants underwent TCT+HPV screening.Based on the screening results,some cases were further evaluated with colposcopy and followed up at 42 days postpartum.Results Among the 3,120 pregnant women screened,132 had abnormal results.Abnormal TCT results were found in 74 cases(2.37%),and HPV16/18 positivity was detected in 87 cases(2.79%).Specifically,58 cases(1.86%)had negative for intraepithelial lesion or malignancy(NILM)with HPV16/18 positive;6 cases(0.19%)had atypical squamous cells of undetermined significance(ASCUS)with HPV16/18 negative;9 cases(0.29%)had ASC-US with HPV16/18 positive;27 cases(0.87%)had low-grade squamous intraepithelial lesions(LSIL)with HPV16/18 negative;13 cases(0.42%)had LSIL with HPV16/18 positive;12 cases(0.38%)had ASC-H or high-grade squamous intraepithelial lesions(HSIL)with HPV16/18 negative;and 7 cases(0.22%)had ASC-H or HSIL with HPV16/18 positive.A total of 32 pregnant women with LSIL+HPV16/18 positive,ASC-H or HSIL with HPV16/18 negative,and ASC-H or HSIL with HPV16/18 positive underwent colposcopy during pregnancy.Pathological reports revealed no invasive cervical cancer;findings included normal or inflammation in 10 cases,cervical intraepithelial neoplasia grade 1(CIN 1)in 15 cases,CIN 2 in 5 cases,and CIN 3 in 2 cases.At 42 days postpartum,132 women with abnormal results underwent repeat TCT+HPV and colposcopy.Abnormal TCT results were found in 34 cases,and abnormal HPV results in 36 cases.Postpartum colposcopy showed no invasive cervical cancer;findings included normal or inflammation in 104 cas

关 键 词：围生期 宫颈癌前病变 宫颈液基细胞学检查 人乳头瘤病毒 阴道镜 

分 类 号：R737.33[医药卫生—肿瘤] R714.2[医药卫生—临床医学]