Nessa Ashrafun, Rashid Mohammad Harun Ur, E-Ferdous Noor, Chowdhury Afroza
Department of Obstetrics and Gynaecology, Gynaecological Oncology Unit, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
J Obstet Gynaecol Res. 2013 Feb;39(2):564-71. doi: 10.1111/j.1447-0756.2012.01998.x. Epub 2012 Aug 26.
To evaluate the feasibility of the 'see and treat' protocol for the management of high-grade cervical intraepithelial neoplasia (CIN) at a colposcopy clinic in Bangladesh.
A cross-sectional and comparative study was carried out between two periods on 358 colposcopy-diagnosed high-grade CIN at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU). During the first period (January 2005 to June 2008), 181 colposcopy-diagnosed high-grade CIN patients had cervical biopsy by punch biopsy forceps and histology-confirmed high-grade CIN were treated by loop electrosurgical excision procedure (LEEP). During the second period (July 2008 to December 2009), 177 colposcopy-diagnosed high-grade CIN were treated by LEEP at their first visit.
During the first and second periods, 48 of 87 and 55 of 73 histology-proven high-grade CIN cases, respectively, received treatment. Among the study population, 37.3% women who had normal or CIN-I in histology were treated unnecessarily in the second period. The compliance of treatment improved by 20% and failure to receive treatment fell by 20%; these changes were statistically significant (P=0.006).
'See and treat' protocol is a well-accepted, feasible and useful option for management of high-grade CIN in Bangladesh. It reduces the number of visits to the clinic and failure to receive treatment.
评估在孟加拉国一家阴道镜诊所采用“即诊即治”方案管理高级别宫颈上皮内瘤变（CIN）的可行性。
在两个时间段内，对达卡班加班杜·谢赫·穆吉布医科大学（BSMMU）阴道镜诊所358例经阴道镜诊断为高级别CIN的患者进行了横断面比较研究。在第一个时间段（2005年1月至2008年6月），181例经阴道镜诊断为高级别CIN的患者通过活检钳进行宫颈活检，组织学确诊为高级别CIN的患者采用环形电切术（LEEP）治疗。在第二个时间段（2008年7月至2009年12月），177例经阴道镜诊断为高级别CIN的患者在首次就诊时即接受LEEP治疗。
在第一个和第二个时间段，分别有87例和73例经组织学证实为高级别CIN的病例中，48例和55例接受了治疗。在研究人群中，第二个时间段有37.3%组织学结果为正常或CIN-I的女性接受了不必要的治疗。治疗依从性提高了20%，未接受治疗的比例下降了20%；这些变化具有统计学意义（P=0.006）。
“即诊即治”方案是孟加拉国管理高级别CIN的一种广泛接受、可行且有用的选择。它减少了患者到诊所的就诊次数以及未接受治疗的情况。
