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目的研究妊娠期宫颈上皮内瘤变(CIN)发生率、转归及处理。方法对3423例妊娠期妇女进行宫颈细胞学(TCT)检查,同时对诊断为CIN的孕妇进行严密的妊娠期和产后随访。结果 3423例妊娠期妇女TCT异常的发生率为1.55%(53/3423)。对其中26例进行了阴道镜检查并活检,7例为正常或炎症,2例呈湿疣样变,5例为CINⅠ级,7例为CINⅡ级,3例为CINⅢ级,1例原位癌,1例宫颈癌Ⅰa期。13例CIN患者产后半年内复查,CINⅠ患者中2例分别进展为CINⅡ累腺和宫颈癌Ⅰa期,CINⅡ患者中1例进展为原位癌,CINⅢ及原位癌患者中2例病变持续,未见进展。结论 TCT、阴道镜检查及必要时的宫颈活检是妊娠期宫颈病变筛查有效且安全的方法;妊娠期各级CIN都有进展的可能,严密随访是安全可靠的处理方式。
Objective To study the incidence, outcome and treatment of cervical intraepithelial neoplasia (CIN) during pregnancy. Methods A total of 3423 gestational women underwent cervical cytology (TCT). Pregnant women diagnosed with CIN were followed up closely during pregnancy and postnatal period. Results The incidence of abnormal TCT in 3423 pregnant women was 1.55% (53/3423). Colposcopy and biopsy were performed on 26 of them, 7 were normal or inflammatory, 2 were condylomata, 5 were CIN I, 7 were CIN II, 3 were CIN III, 1 were carcinoma in situ, 1 case of cervical cancer Ⅰ a period. Thirteen patients with CIN were reviewed within six months after birth. Two of CINⅠ patients progressed to CINⅡ and adenocarcinoma Ⅰa. One of CINⅡ patients progressed to carcinoma in situ, and two of CINⅢ and carcinoma in situ were persistent. See progress. Conclusions TCT, colposcopy and cervical biopsy when necessary are effective and safe screening methods for cervical lesions in pregnancy. CIN at all levels of pregnancy may have the possibility of progress. Close follow-up is a safe and reliable treatment.