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目的研究深圳城市人群子宫颈癌早诊早治的适宜方式。方法2006～2007年采取整群随机抽样方法获得福田区教育局和龙岗区龙城街道紫薇社区样本人群及2005～2008年深圳市妇幼保健院妇科门诊机会性筛查人群。以上人群分别由学校工会和社区居委会、计划生育服务站宣教和组织;机会性筛查人群由妇科门诊护士和医师宣教和推荐。采用细胞学检查、HPV-DNA检测的筛查方法,异常者转诊阴道镜及病理诊断,病理诊断为金标准。采用筛查率、早诊率、早治率和行政费用率进行评价。结果2006年福田区教育局系统中小学教职工筛查率77.32%,紫薇社区人群筛查率18.56%,差异有统计学意义(x~2=3005.435,P=0.000);两组人群早诊率100%,治疗率均在90%以上。2005～2008年深圳市妇幼保健院子宫颈癌机会性筛查干预后有连续增长趋势(x~2=1588.5503,P=0.000)。2004～2008年子宫颈癌早诊率年平均89.85%,5年早诊率差异无统计学意义(x~2=6.513,P=0.164)。2006～2008年治疗率明显增高(x~2=123.090,P=0.000)。机会性筛查行政费用率明显低于组织性筛查(x~2=30.626,P=0.000)。结论城市人群子宫颈筛查以工作单位或社区居委会计划生育服务站组织为佳;机会性筛查可做为城市人群子宫颈癌组织性筛查的重要补充,门诊医师的宣教可提高机会性筛查率;城市人群子宫颈癌筛查宜提倡组织性筛查与机会性筛查相结合。
Objective To study the appropriate method of early diagnosis and early diagnosis of cervical cancer in Shenzhen urban population. Methods From 2006 to 2007, a sample randomized cluster sampling method was used to obtain community samples from the Futian District Education Bureau and Longcheng Street in Longcheng District and the screening opportunities for gynecological clinics in Shenzhen MCH from 2005 to 2008. The above groups were educated and organized by school unions, community committees and family planning service stations, respectively; and the opportunistic screening population was advocated and recommended by gynecological clinic nurses and physicians. Using cytology, HPV-DNA test screening methods, referral colposcopy abnormalities and pathological diagnosis, pathological diagnosis as the gold standard. Screening rates, early diagnosis rates, early treatment rates, and administrative costs rates were used for evaluation. Results The screening rate of primary and secondary school staff in Futian District Board of Education was 77.32% in 2006 and 18.56% in the community of crape myrtle, the difference was statistically significant (x ~ 2 = 3005.435, P = 0.000). The rate of early diagnosis 100%, the treatment rate is above 90%. From 2005 to 2008, there was a continuous increase tendency of cervical cancer screening in Shenzhen Maternal and Child Health Hospital (x ~ 2 = 1588.5503, P = 0.000). The average annual rate of cervical cancer diagnosis from 2004 to 2008 was 89.85%. There was no significant difference in the 5-year early diagnosis rate (x ~ 2 = 6.513, P = 0.164). From 2006 to 2008, the treatment rate was significantly higher (x ~ 2 = 123.090, P = 0.000). The opportunistic screening administrative cost rate was significantly lower than the organizational screening (x ~ 2 = 30.626, P = 0.000). Conclusion Cervical screening in urban population is better organized by family planning service stations in community or work units. Opportunistic screening can be an important complement to cervical cancer screening in urban areas. Outreach by doctors in outpatient setting can improve opportunistic screening Cervical cancer screening should promote the combination of screening and opportunistic screening.