Douvier S, Filipuzzi L, Sagot P
Clinique gynécologique, CHU de Dijon, 10, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon, France.
Gynecol Obstet Fertil. 2003 Oct;31(10):851-5. doi: 10.1016/j.gyobfe.2002.12.001.
Approximately 30% of women diagnosed with cervical cancer are in their childbearing years. Prenatal care provides an excellent opportunity for cervical cancer screening. The incidence of abnormal Pap smear has been reported in 5-8% of pregnant women. But we must know that Pap smears have cytologic modifications because of pregnancy. All abnormal smears have to be referred to colposcopic examination. The squamocolumnar junction is visualized in almost 100% of cases. The sensitivity of colposcopy is nearly 87% with complete concordance in 72.6%. Colposcopically directed biopsies have a good correlation with the final diagnosis with very minimal risks for both mother and fetus. The high rate of complications (hemorrhage, abortion, premature labor) and residual lesions in half of cases do not encourage conization during pregnancy. The final treatment is carried out after delivery. The only absolute indication for conization in pregnancy is to rule out microinvasive disease or make the diagnosis of invasive carcinoma when such a diagnosis will alter the timing of delivery but also when there is a no satisfactory colposcopy and a high-grade Pap smear. In these cases conization is performed for diagnostic and not therapeutic purpose. We must be aware of the high rate of loss of follow-up (6-33%).
约30%被诊断为宫颈癌的女性处于育龄期。产前检查为宫颈癌筛查提供了绝佳机会。据报道，5%-8%的孕妇巴氏涂片异常。但我们必须知道，由于怀孕，巴氏涂片会有细胞学改变。所有异常涂片都必须转诊至阴道镜检查。几乎100%的病例都能看到鳞柱交界。阴道镜检查的敏感性约为87%，完全符合率为72.6%。阴道镜引导下活检与最终诊断有良好的相关性，对母亲和胎儿的风险都非常小。高并发症发生率（出血、流产、早产）以及半数病例中的残留病变不支持在孕期进行锥切术。最终治疗在分娩后进行。孕期锥切术的唯一绝对指征是排除微浸润性疾病或在诊断为浸润性癌时，该诊断不仅会改变分娩时机，而且在阴道镜检查不满意且巴氏涂片为高级别时。在这些情况下，锥切术是出于诊断目的而非治疗目的。我们必须意识到失访率很高（6%-33%）。
