基层医疗中宫颈上皮内瘤变的诊断与治疗
Diagnosis and treatment of cervical intraepithelial neoplasia in general practice.
作者信息
Johnson D B, Rowlands C J
机构信息
Brecon Medical Group Practice.
出版信息
BMJ. 1989 Oct 28;299(6707):1083-6. doi: 10.1136/bmj.299.6707.1083.
OBJECTIVE
To audit the first five years of a colposcopy and treatment service for cervical dysplasia established within a general practice.
DESIGN
A cervical smear register was established to determine which women were "at risk" of dysplasia. The results of colposcopy and treatment of dysplasia were analysed.
SETTING
A large rural general practice with community hospital facilities in mid-Wales.
PATIENTS
4437 Women at risk in a total practice population of 14,100.
INTERVENTIONS
Colposcopy of women with dyskaryotic smear results, persistent inflammatory smear results, or vulval warts. Treatment of women with proved dysplasia by electrodiathermy of the cervix or cone biopsy.
RESULTS
138 Women with dysplasia were diagnosed over five years: 36 mild, 97 moderate or severe, and five with microinvasion. Despite a 78% smear rate of at risk women over five years, nine invasive cancers still occurred.
CONCLUSIONS
The results of treatment are acceptable. Cervical dysplasia has become very common, the risk of a dysplasia in women aged 20-39 who had smear tests being one in 14 over five years.
目的
对在一家普通诊所设立的宫颈发育异常阴道镜检查及治疗服务的头五年进行审核。
设计
建立宫颈涂片登记册以确定哪些女性存在发育异常“风险”。分析阴道镜检查及发育异常治疗的结果。
地点
威尔士中部一家配备社区医院设施的大型乡村普通诊所。
患者
在总共14100人的诊所人群中有4437名有风险的女性。
干预措施
对涂片结果为核异质、持续性炎性涂片结果或患有外阴疣的女性进行阴道镜检查。对经证实为发育异常的女性通过宫颈电灼或锥形活检进行治疗。
结果
五年内共诊断出138例发育异常女性：36例轻度，97例中度或重度，5例微浸润。尽管五年内有风险女性的涂片率为78%，但仍发生了9例浸润性癌。
结论
治疗结果可以接受。宫颈发育异常已变得非常普遍，在接受涂片检查的20 - 39岁女性中，五年内发生发育异常的风险为十四分之一。
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