Yamazaki Tatsuo, Inaba Fujiyuki, Takeda Nobuhiko, Furuno Makiko, Kamemori Tetsu, Kosaka Nobuaki, Ohta Yoriko, Fukasawa Ichio, Inaba Noriyuki
Department of Obstetrics and Gynecology, Dokkyo University School of Medicine, 880 Kita-kobayashi, Mibu-machi, Shimotsuga-gun, 321-0293 Tochigi, Japan.
Arch Gynecol Obstet. 2006 Mar;273(6):355-9. doi: 10.1007/s00404-005-0063-5. Epub 2005 Oct 6.
During the 4-year routing study of smears in 2,919 pregnant women, 33 cases of abnormalities of the uterine cervix were detected (1.13%). The patients were followed with uterine cervical cytology and colposcopy, and in case of need, sometimes punch biopsies were performed. As a result of the cytologies, 33 cases with abnormalities were detected. There were 26 cases classified as class IIIa and 7 cases were class IIIb. All cases underwent colposcopy. For the 17 cases that showed lesions by colposcopy, punch biopsies were performed. The results of histologic examination were wide: 5 chronic cervicitis, 1 condyloma, 1 mild dysplasia, 3 moderate dysplasia, 3 severe dysplasia, 3 carcinoma in situ, and 1 microinvasive carcinoma. Only two cases were treated during pregnancy, condyloma underwent Laser vaporization and microinvasive carcinoma underwent Loop electrosurgical excision procedure (LEEP) conization. Other cases were conservative treatment during pregnancy. Excluding one case for persistence smear class IIIa of histology condyloma, all the other cases with regression of dysplasia and carcinoma in situ with treatment after delivery. We conclude that lesions up to carcinoma in situ do not require intervention during pregnancy but microinvasive carcinoma is suspected, diagnostic LEEP conization is necessary, even during pregnancy.
在对2919名孕妇进行的为期4年的涂片常规检查中，检测到33例宫颈异常（1.13%）。对患者进行宫颈细胞学检查和阴道镜检查，必要时有时进行活检。细胞学检查结果显示，共检测到33例异常病例。其中26例被分类为IIIa级，7例为IIIb级。所有病例均接受了阴道镜检查。对阴道镜检查显示有病变的17例病例进行了活检。组织学检查结果多种多样：5例慢性宫颈炎，1例尖锐湿疣，1例轻度发育异常，3例中度发育异常，3例重度发育异常，3例原位癌，1例微浸润癌。孕期仅对2例进行了治疗，尖锐湿疣采用激光汽化治疗，微浸润癌采用环形电切术（LEEP）锥切术。其他病例在孕期采用保守治疗。除1例组织学检查为尖锐湿疣的涂片持续为IIIa级外，所有其他发育异常和原位癌病例在产后经治疗后均有好转。我们得出结论，原位癌及以下病变在孕期无需干预，但如果怀疑为微浸润癌，即使在孕期也有必要进行诊断性LEEP锥切术。
