Gemmell J, Holmes D M, Duncan I D
Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee.
Br J Obstet Gynaecol. 1990 Jan;97(1):58-61. doi: 10.1111/j.1471-0528.1990.tb01717.x.
A retrospective longitudinal review identified 341 women who had had a hysterectomy in association with CIN 3, in Tayside Region, during the years 1967-1977; 219 (64%) had completed 10 years of cytology follow-up and of 140 women eligible for 15-year smears 79 (56%) completed the 15-year follow-up. Eight (4%) of the 219 patients developed abnormal cytology, but in six, smears reverted to normal spontaneously. Two patients had persistently abnormal smears and vaginal intraepithelial neoplasia (VAIN) was diagnosed. Only one patient completing 15-year follow-up had an abnormal smear and VAIN later diagnosed. No patient over this 15-year period developed invasive vaginal carcinoma. Sixty vaginal carcinomas were identified during the period 1957-1987 from the gynaecology cancer register; only one was associated with a previous diagnosis of CIN 3 at hysterectomy. With such data we would propose screening 6-monthly during the first post-operative year and then at 2 years. If these smears were normal, the patient could then revert to the normal screening programme.
一项回顾性纵向研究确定了1967年至1977年间在泰赛德地区因宫颈上皮内瘤变3级（CIN 3）而接受子宫切除术的341名女性；219名（64%）完成了10年的细胞学随访，在140名符合15年涂片检查条件的女性中，79名（56%）完成了15年的随访。219名患者中有8名（4%）出现细胞学异常，但其中6名患者的涂片检查后来自发恢复正常。2名患者的涂片检查持续异常，并被诊断为阴道上皮内瘤变（VAIN）。在完成15年随访的患者中，只有1名患者的涂片检查异常，后来被诊断为VAIN。在这15年期间，没有患者发生浸润性阴道癌。在1957年至1987年期间，从妇科癌症登记处识别出60例阴道癌；只有1例与子宫切除术前诊断为CIN 3有关。根据这些数据，我们建议在术后第一年每6个月进行一次筛查，然后在2年后进行筛查。如果这些涂片检查正常，患者随后可恢复正常的筛查计划。
