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目的探索适合宫颈癌高发且经济欠发达地区子宫颈癌及其癌前病变的筛查方法,以最终降低子宫颈癌的发病率和死亡率。方法以山西省襄垣县下良乡35￣55岁的妇女作为对象,进行以人群为基础的宫颈癌筛查。对符合条件的妇女进行危险因素、癌症及子宫颈癌认知情况的问卷调查,用醋酸染色后肉眼观察(VIA)和碘染色后肉眼观察(VILI)进行宫颈检查,结果异常者进行阴道镜下活组织检查并得到最终的病理学诊断。将该次筛查对不同级别病变的检出率与历年来的襄垣地区的筛查结果进行比较。结果该次筛查人群参与率为74.8%。患宫颈糜烂和滴虫感染的妇女分别占受检人群的48.3%和14.8%。最终经活检病理确诊的CINⅠ的现患率为0.8%(10例)、CINⅡ0.7%(9例)、CINⅢ1.1%(13例)、子宫颈癌0.2%(3例)。该次单纯肉眼观察对CINⅡ和对≥CINⅢ病变的检出率略低于已往当地普查项目,但差别无统计学意义。结论在资源有限,经济不发达的农村地区,由经过培训的医生进行肉眼观察的宫颈癌筛查是可行的,单纯肉眼观察是一种经济有效的筛查方法,建议进一步在农村地区进行推广。
Objective To explore a suitable screening method for cervical cancer and its precancerous lesions in areas with high incidence of cervical cancer and undeveloped areas so as to ultimately reduce the incidence and mortality of cervical cancer. Methods A 35- to 55-year-old woman from Xia Liangxiang, Xiangyuan County, Shanxi Province, was selected as the target for population-based cervical cancer screening. Questionnaire surveys of risk factors, cancer and cervical cancer among eligible women were performed. Cervical examinations were performed with visual inspection (VIA) after acetic acid staining and visual inspection (VILI) after iodine staining. The patients with abnormal results underwent colposcopy Biopsy and get the final pathological diagnosis. The detection rate of this screening on different levels of disease and Xiangyuan over the years the screening results were compared. Results The participation rate of this screening population was 74.8%. Women suffering from cervical erosion and trichomoniasis accounted for 48.3% and 14.8% of the population under test respectively. The prevalence of CINⅠ confirmed by biopsy was 0.8% (10 cases), CINⅡ 0.7% (9 cases), CINⅢ1.1% (13 cases) and cervical cancer 0.2% (3 cases). The simple visual observation of CIN Ⅱ and ≥ CIN Ⅲ lesion detection rate slightly lower than the previous local census projects, but the difference was not statistically significant. Conclusion In rural areas with limited resources and underdeveloped economy, cervical cancer screening by trained doctors is feasible and naked eye observation is a cost-effective screening method, which is recommended for further promotion in rural areas.