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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1287人连续筛查了3年,第1轮筛查CIN2、CIN3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轮筛查仅增加了1例CIN2病例。2006～2007年期间对3490人连续筛查了2年,第1轮(3490人)与第2轮(2943人)筛查CIN2、CIN3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2368例人群连续筛查了2年,第1轮(2368人)与第2轮(2040人)筛查对于CIN2、CIN3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(7145)的CIN2、CIN3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CIN2、69.81%(37例)的CIN3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(Ⅰa)。在查出的宫颈早期病变中,CIN1、CIN2、CIN3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CIN2和2/3以上的CIN3及几乎所有的癌症;连续筛查2次,可以提高人群中CIN2、CIN3病变的检出率。
Background and Objective: To date, there is not a systematic plan for cervical cancer prevention and control in our country, especially the prevention and treatment of cervical cancer in rural areas. This study reports the population screening data of early diagnosis and early diagnosis and treatment of cervical cancer in Xiangyuan County of Shanxi Province. It evaluates the screening of cervical cancer and its precancerous lesions in rural areas by primary physicians using acetic acid or iodine staining (VIA / VILI) effect. Methods: Cervical cancer screening was carried out in women aged 30-59 years in Xiangyuan County, Shanxi Province by acetic acid staining (VIA) and iodine staining (VILI). VIA or VILI positive patients underwent colposcopy and colposcopy abnormalities Take biopsy at the lesion for pathological diagnosis. The same procedure was used to review the population, and the screening results of this protocol were evaluated by comparing the results of 1-year screening, 2-year continuous screening and 3-year continuous screening. Results: Between 2005 and 2008, 7,145 women of the same age participated in the screening, with an average age of 42.16 years and an average of 74.75% of the screening population. Among them, 1,257 consecutively screened for 3 years between 2005 and 2007, the detection rates of CIN2, CIN3 and cervical cancer in the first round were 0.70% (9 cases), 1.01% (13 cases) and 0.23 (3 cases). The detection rate of the second round (976 persons) was 0.22% (2 cases) and 0.11% (1 case) respectively. The third screening only increased one case of CIN2. 3490 people were screened continuously for 2 years from 2006 to 2007. The detection rates of CIN2, CIN3 and cervical cancer in the first round (3490) and the second round (2943) were 0.26% (9 cases ), 0.52% (18 cases), 0.15% (5 cases) and 0.40% (14 cases), 0.40% (14 cases) and 0.03% (1 case). In the same period from 2007 to 2008, 2,368 people were continuously screened for 2 years. The detection rates of CIN2, CIN3 and cervical cancer in the first round (2368) and the second round (2040) were 0.55% (13 cases), 0.25% (6 cases), 0.12% (3 cases), 0.42% (10 cases) and 0.04% (1 case) from 2005 to 2008. All the patients (7145) The cumulative detection rates of CIN3 and cervical cancer were 0.81% (58 cases), 0.74% (53 cases) and 0.17% (12 cases) respectively, of which 53.45% (31 cases) had CIN2, 69.81% (37 cases) And 91.67% of cervical cancers (n = 11) were detected by primary screening, except for one case of early carcinoma (la) found in the second round of screening. Among the detected early cervical lesions, the average age of patients with CIN1, CIN2, CIN3 and cervical cancer were 38.65 years old, 40.61 years old, 44.10 years old and 46.73 years old respectively. Conclusion: In the rural areas with limited resources and underdeveloped economy, screening of cervical cancer and precancerous lesions in women aged 30-59 years by VIA / VILI method by trained primary doctors is feasible. Screening once can Effective detection of more than 50% of CIN2 and 2/3 of CIN3 and almost all of the cancer; continuous screening 2 times, can improve the population CIN2, CIN3 lesions detection rate.