尉艳芹 李为民

[摘要]目的 探讨阴道镜下检查联合人乳头瘤病毒（HPV）、液基薄层细胞学（TCT）检查对宫颈癌（CC）筛查的临床作用。方法 选取2017年7月～2018年7月我院门诊938例CC筛查的受试者作为研究对象，所有受试者均分别采用HPV、TCT检查、阴道镜下检查等方式检查，并以病理学检查结果作为金标准，统计HPV、TCT及两者联合阴道镜下活检三种检查方式诊断CC和不同程度癌前病变的符合率。结果 938例受试者中经病理学检查诊断，817例无上皮内病变，121例为CC及癌前病变阳性，其中CC11例，CINⅠ级病变30例，CINⅡ级病变39例，CINⅢ级病变41例。HPV检查的总体符合率为87.60%（106/121）。TCT检查的总体符合率为85.12%（103/121），而HPV+TCT+阴道镜检查的总体符合率为97.52%（118/121）。TCT和HPV检查两种检查方式对CC和癌前病变的检出符合率比较，差异无统计学意义（P>0.05），而HPV+TCT+阴道镜检查的检出符合率要显著高于HPV、TCT单独诊断，差异有统计学意义（P<0.05）。结论 阴道镜下联合HPV、TCT检查应用于CC的临床筛查，能及早发现癌前病变，改善CC诊断的检出率，减少漏诊，应用价值良好。

[关键词]阴道镜下检查;人乳头瘤病毒;膜式液基薄层细胞学检查;宫颈癌筛查

[中图分类号] R737          [文献标识码] A          [文章编号] 1674-4721（2019）6（c）-0096-03

[Abstract] Objective To investigate the clinical effect of colposcopy combined with human papillomavirus （HPV）， membrane-based thin-layer cytology （TCT） on cervical cancer （CC） screening. Methods A total of 938 cases of CC screening were selected from July 2017 to July 2018 in our hospital. All subjects were examined by HPV， TCT and colposcopy. Based on the results of pathological examination as gold standard， the coincidence rate of HPV， TCT and colposcopy biopsy in the diagnosis of CC and precancerous lesions of different degrees was statistically analyzed. Results There were 817 cases without intraepithelial lesion and 121 cases were positive for CC and precancerous lesion， including 11 cases of CC， 30 cases of CIN Ⅰ grade lesion， 39 cases of CIN Ⅱ grade lesion and 41 cases of CINⅢ  grade lesion. The overall coincidence rate of HPV was 87.60% （106/121）. The overall coincidence rate of HPV TCT colposcopy and colposcopy was 85.12% （103/121） and 97.52% （118/121） respectively. There was no significant difference in the coincidence rate between TCT and HPV in the detection of cervical cancer and precancerous lesions （P>0.05）， but the coincidence rate of HPV+TCT+colposcopy was significantly higher than that of HPV， TCT alone， the difference was statistically significant （P<0.05）. Conclusion Colposcopy combined with HPV， TCT for clinical screening of CC can detect precancerous lesions early， improve the detection rate of CC diagnosis， reduce missed diagnosis， and have a good application value.

[Key words] Colposcopy; Human papillomavirus; Membrane liquid-based thin-layer cytology; Cervical cancer screening

宮颈癌（CC）在妇科临床是比较常见的恶性肿瘤，其发病率在女性所有恶性肿瘤中排名第二位，仅次于乳腺癌[1-2]。而包括中国在内的发展中国家是CC的高发区域，CC患者在全球所占的比例高达80%[3]。流行病学调查研究[4]显示，我国女性新患CC人数在全球新增患者中的比例达到了30%，近年来，患者发病年龄还出现年轻化的状态。虽然这几年，CC的治疗研究有了很大的提升，CC的病死率也有了一定的降低，但早诊断早治疗仍是降低CC患者病死率的关键所在[5-6]。随着人们健康意识的提高，妇科CC的普查筛选工作也得到了广泛的推广。人乳……