Hansell R S, Rogers R E
Dept. of Obstetrics and Gynecology, Indiana University Medical Center, Indianapolis 46202.
Indiana Med. 1990 Jul;83(7):468-73.
Table 2 summarizes the management of the abnormal Pap smear. Management of dysplasia in this institution is aggressive--as destructive therapy of mild dysplasia is advised, opposed to watching the patient and treating only if the disease persists. The rationale for this is the 33% to 45% failure rate for follow-up appointments in the primarily inner-city population served. The key to follow-up is to repeat cervical cytology in all patients treated, even those treated with hysterectomy, every three months until two consecutive normal smears are obtained. At that time, surveillance and intervals may be modified, but screening should continue at least annually. The mortality rate of carcinoma of the cervix has dropped precipitously during the last 40 years, in part, from simple screening of the cervix with the Papanicolaou smear. The effort to treat premalignant changes has been rewarded. The use of the colposcope and destructive forms of therapy have allowed successful treatment of patients with less morbidity and mortality than the immediate reliance on cervical conization. Remember, conization is still indicated and prudent in selected patients. Following these guidelines may contribute to the downward trend.
表2总结了巴氏涂片异常的处理方法。本机构对发育异常的处理较为积极——建议对轻度发育异常进行破坏性治疗，而不是观察患者，仅在疾病持续存在时才进行治疗。这样做的理由是，在主要服务的市中心城区人群中，随访预约的失访率为33%至45%。随访的关键是对所有接受治疗的患者，即使是接受子宫切除术的患者，每三个月重复进行宫颈细胞学检查，直到获得连续两次正常涂片。届时，可调整监测和间隔时间，但筛查应至少每年继续进行。在过去40年中，宫颈癌的死亡率急剧下降，部分原因是通过巴氏涂片对宫颈进行简单筛查。治疗癌前病变的努力得到了回报。阴道镜的使用和破坏性治疗方式使得患者能够成功接受治疗，其发病率和死亡率低于立即依赖宫颈锥切术的情况。请记住，在某些特定患者中，锥切术仍然是必要且谨慎的。遵循这些指南可能有助于这种下降趋势。
