癌症
癌癥
암증
CHINESE JOURNAL OF CANCER
2010年
1期
4-8
,共5页
张永贞%马俊飞%赵方辉%向喜娥%马朝辉%石樱桃%胡尚英%乔友林
張永貞%馬俊飛%趙方輝%嚮喜娥%馬朝輝%石櫻桃%鬍尚英%喬友林
장영정%마준비%조방휘%향희아%마조휘%석앵도%호상영%교우림
子宫颈癌%醋酸染色法%碘染色法%筛查%农村
子宮頸癌%醋痠染色法%碘染色法%篩查%農村
자궁경암%작산염색법%전염색법%사사%농촌
cervical cancer%visual inspection with aceticacid%visual inspection with Lugol's iodine%screening%rural areas
背景与目的:我国至今还没有一个系统的子宫颈癌防治计划,尤其是广大农村地区更缺乏子宫颈癌的防治技术和经验.本研究报道山西省襄垣县子宫颈癌早诊早治示范基地的人群筛查资料.评价基层医生采用醋酸或碘染色法(VIA/VILI)在农村地区筛查子宫颈癌及其癌前病变的效果.方法:采用醋酸染色法(VIA)和碘染色法(VILI)在山西省襄垣县30～59岁的妇女人群中开展子宫颈癌筛查,VIA或VILI阳性者进行阴道镜检查,阴道镜检异常者在病变处取活检进行病理学诊断.采用同样的程序对人群进行复查,通过比较1年筛查、连续2年筛查和连续3年筛查的结果,评价该方案的筛查效果.结果:在2005～2008年期间,有7145名适龄妇女参加了筛查,平均年龄为42.16岁,筛查人群平均参与率为74.75%.其中2005～2007年期间,对1 287人连续筛查了3年,第1轮筛查CIN 2、CIN 3及子宫颈癌的检出率分别为0.70%(9例)、1.01%(13例)、0.23%(3例);第2轮(976人)筛查检出率分别为0.22%(2例)、0.11%(1例)、0;第3轮筛查仪增加了1例CIN 2病例.2006～2007年期间对3 490人连续筛查了2年,第1轮(3 490人)与第2轮(2 943人)筛查CIN 2、CIN 3及子宫颈癌的检出率分别为0.26%(9例)、0.52%(18例)、0.15%(5例)和0.40%(14例)、0.40%(14例)、0.03%(1例).同样2007～2008年期间对2 368例人群连续筛查了2年,第1轮(2 368人)与第2轮(2 040人)筛查对于CIN 2、CIN 3及子宫颈癌的检出率分别为0.55%(13例)、0.25%(6例)、0.12%(3例)和0.42%(10例)、0.04%(1例)、0.2005～2008年期间筛查全部人群(7 145)的CIN 2、CIN 3和子宫颈癌的累计检出率分别为0.81%(58例)、0.74%(53例)和0.17%(12例),其中53.45%(31例)的CIN 2、69.81%(37例)的CIN 3和91.67%的子宫颈癌(11例)是通过初次筛查发现的,除了第2轮筛查发现的1例早期癌(Ⅰ a).在查出的宫颈早期病变中,CIN 1、CIN 2、CIN 3和子宫颈癌患者平均年龄分别为38.65岁、40.61岁、44.10岁、46.73岁.结论:在资源有限、经济欠发达的农村地区.由经过培训的基层医生用VIA/VILI方法对30～59岁妇女开展子宫颈癌及其癌前病变的筛查是可行的,筛查一次可以有效检出50%以上的CIN 2和2/3以上的CIN 3及几乎所有的癌症:连续筛查2次,可以提高人群中CIN 2、CIN 3病变的检出率.
揹景與目的:我國至今還沒有一箇繫統的子宮頸癌防治計劃,尤其是廣大農村地區更缺乏子宮頸癌的防治技術和經驗.本研究報道山西省襄垣縣子宮頸癌早診早治示範基地的人群篩查資料.評價基層醫生採用醋痠或碘染色法(VIA/VILI)在農村地區篩查子宮頸癌及其癌前病變的效果.方法:採用醋痠染色法(VIA)和碘染色法(VILI)在山西省襄垣縣30～59歲的婦女人群中開展子宮頸癌篩查,VIA或VILI暘性者進行陰道鏡檢查,陰道鏡檢異常者在病變處取活檢進行病理學診斷.採用同樣的程序對人群進行複查,通過比較1年篩查、連續2年篩查和連續3年篩查的結果,評價該方案的篩查效果.結果:在2005～2008年期間,有7145名適齡婦女參加瞭篩查,平均年齡為42.16歲,篩查人群平均參與率為74.75%.其中2005～2007年期間,對1 287人連續篩查瞭3年,第1輪篩查CIN 2、CIN 3及子宮頸癌的檢齣率分彆為0.70%(9例)、1.01%(13例)、0.23%(3例);第2輪(976人)篩查檢齣率分彆為0.22%(2例)、0.11%(1例)、0;第3輪篩查儀增加瞭1例CIN 2病例.2006～2007年期間對3 490人連續篩查瞭2年,第1輪(3 490人)與第2輪(2 943人)篩查CIN 2、CIN 3及子宮頸癌的檢齣率分彆為0.26%(9例)、0.52%(18例)、0.15%(5例)和0.40%(14例)、0.40%(14例)、0.03%(1例).同樣2007～2008年期間對2 368例人群連續篩查瞭2年,第1輪(2 368人)與第2輪(2 040人)篩查對于CIN 2、CIN 3及子宮頸癌的檢齣率分彆為0.55%(13例)、0.25%(6例)、0.12%(3例)和0.42%(10例)、0.04%(1例)、0.2005～2008年期間篩查全部人群(7 145)的CIN 2、CIN 3和子宮頸癌的纍計檢齣率分彆為0.81%(58例)、0.74%(53例)和0.17%(12例),其中53.45%(31例)的CIN 2、69.81%(37例)的CIN 3和91.67%的子宮頸癌(11例)是通過初次篩查髮現的,除瞭第2輪篩查髮現的1例早期癌(Ⅰ a).在查齣的宮頸早期病變中,CIN 1、CIN 2、CIN 3和子宮頸癌患者平均年齡分彆為38.65歲、40.61歲、44.10歲、46.73歲.結論:在資源有限、經濟欠髮達的農村地區.由經過培訓的基層醫生用VIA/VILI方法對30～59歲婦女開展子宮頸癌及其癌前病變的篩查是可行的,篩查一次可以有效檢齣50%以上的CIN 2和2/3以上的CIN 3及幾乎所有的癌癥:連續篩查2次,可以提高人群中CIN 2、CIN 3病變的檢齣率.
배경여목적:아국지금환몰유일개계통적자궁경암방치계화,우기시엄대농촌지구경결핍자궁경암적방치기술화경험.본연구보도산서성양원현자궁경암조진조치시범기지적인군사사자료.평개기층의생채용작산혹전염색법(VIA/VILI)재농촌지구사사자궁경암급기암전병변적효과.방법:채용작산염색법(VIA)화전염색법(VILI)재산서성양원현30～59세적부녀인군중개전자궁경암사사,VIA혹VILI양성자진행음도경검사,음도경검이상자재병변처취활검진행병이학진단.채용동양적정서대인군진행복사,통과비교1년사사、련속2년사사화련속3년사사적결과,평개해방안적사사효과.결과:재2005～2008년기간,유7145명괄령부녀삼가료사사,평균년령위42.16세,사사인군평균삼여솔위74.75%.기중2005～2007년기간,대1 287인련속사사료3년,제1륜사사CIN 2、CIN 3급자궁경암적검출솔분별위0.70%(9례)、1.01%(13례)、0.23%(3례);제2륜(976인)사사검출솔분별위0.22%(2례)、0.11%(1례)、0;제3륜사사의증가료1례CIN 2병례.2006～2007년기간대3 490인련속사사료2년,제1륜(3 490인)여제2륜(2 943인)사사CIN 2、CIN 3급자궁경암적검출솔분별위0.26%(9례)、0.52%(18례)、0.15%(5례)화0.40%(14례)、0.40%(14례)、0.03%(1례).동양2007～2008년기간대2 368례인군련속사사료2년,제1륜(2 368인)여제2륜(2 040인)사사대우CIN 2、CIN 3급자궁경암적검출솔분별위0.55%(13례)、0.25%(6례)、0.12%(3례)화0.42%(10례)、0.04%(1례)、0.2005～2008년기간사사전부인군(7 145)적CIN 2、CIN 3화자궁경암적루계검출솔분별위0.81%(58례)、0.74%(53례)화0.17%(12례),기중53.45%(31례)적CIN 2、69.81%(37례)적CIN 3화91.67%적자궁경암(11례)시통과초차사사발현적,제료제2륜사사발현적1례조기암(Ⅰ a).재사출적궁경조기병변중,CIN 1、CIN 2、CIN 3화자궁경암환자평균년령분별위38.65세、40.61세、44.10세、46.73세.결론:재자원유한、경제흠발체적농촌지구.유경과배훈적기층의생용VIA/VILI방법대30～59세부녀개전자궁경암급기암전병변적사사시가행적,사사일차가이유효검출50%이상적CIN 2화2/3이상적CIN 3급궤호소유적암증:련속사사2차,가이제고인군중CIN 2、CIN 3병변적검출솔.
Background and Objective: In China,there is not an established national program for prevention and treatment of cervical cancer,and the screening methods and experiences are especially lack in the rural areas. This study was to evaluate the effect of visual inspection with acetic acid/ Lugors iodine (VIA/VILI) used as an alternative cervical cancer screening method in the rural areas in China by analyzing the large-scale population-based screening data from the demonstration site. Methods: Women aged 30-59 years from Xiangyuan County in Shanxi Province were recruited for Cervical cancer screening from 2005 to 2007. VIA/VILI was the primary screening method followed by colposcopy if the VIA/VILI result was positive. cervical lesions were diagnosed by directed biopsy under the colposcopy. The women with VIA/VILI negative or cervical intraepithelial neoplasia (CIN) 1 were re-screened using the same procedure in the next year. The screening effect was evaluated by comparing the screening results. Results: Of 9558 women involved,7145 (74.75%),with mean age of 42.16 years,received the cervical cancer screening. A total of 1287 women were consecutively screened for three times during 2005-2007. The detection rates of CIN 2,CIN 3,and cervical cancer were 0.70% (9/1287),1.01% (13/1287),and 0.23% (3/1287) in the first round screening,and 0.22% (2/976),0.11% (1/976),and 0% (0/976) in the second round screening,respectively. Only one CIN 2 was found in the third round screening. During 2006-2007,3490 women were screened consecutively twice; the detection rates of CIN 2,CIN 3,and cervical cancer were 0.26% (9/3490),0.52% (18/3490),and 0.15% (5/3490) in the first round screening,and 0.40% (14/2943),0.40% (14/2943),and 0.03% (1/2943) for the second round screening,respectively. Likewise,2368 women were screened consecutively twice during 2007-2008; the detection rates of CIN 2,CIN 3,and cervical cancer were 0.55% (13/2368),0.25% (6/2368),and 0.12% (3/2368) in the first round screening,and 0.42% (10/2040),p.04%(1/2040),and 0% in the second round screening. The cumulative-detection rates for CIN 2,CIN 3,and cervical cancer were 0.81% (58/7145),0.74% (53/7145),and 0.17% (12/7145),respectively,in which 53.45% (31/58) of CIN 2,69.81% (37/53) of CIN 3,and almost all (11/12) cervical cancer were found during the first round screening; only 1 of 12 was found to be early stage cervical cancer (1a) in the second round screening. The mean ages of patients with CIN 1,CIN 2,CIN 3,and cervical cancer were 38.65,40.61,44.10,and 46.73 years,respectively. Conclusions. VIA/VILI could be used as an alternative screening method for cervical cancer and high-grade precancerous lesions among the women aged 30-59 years in rural areas due to its low cost,easy training for the local health providers,and less depending on facilities. One round screening by VIA/VILI could detect more than a half of CIN 2,two-thirds of CIN 3,and almost all the cervical cancer in the population,and the detection rate of CIN2/3 can be increased by two consecutive rounds of screening.
