摘要子宫颈癌是导致女性患者死亡的第二位妇科恶性肿瘤,妇产科医生掌握其发生发展过程中所涉及的细胞变异、新生组织的发病机制,可以极大地提升宫颈癌筛查效力.在宫颈癌筛查过程中,裸眼检查可见宫颈组织增生,同时伴有出血,符合异常细胞和异常血管增生的条件,此时高度可疑宫颈癌,有条件时,立即取宫颈异常部位的组织送病理,没有条件立即转诊阴道镜下取活检;如裸眼检查未发现宫颈异常,进行宫颈癌常规筛查,取宫颈脱落细胞单独行细胞学筛查,或者细胞学检查联合高危型人乳头瘤病毒检测进行联合筛查,无论采用何种筛查手段,筛查结果预测罹患宫颈癌前病变或者以上病变的风险大于5%,需要转诊阴道镜,阴道镜下在异常血管增生的区域,应用5%醋酸作用后观察是否有醋白上皮出现,出现后符合异常细胞和异常血管增生,高度可疑宫颈癌前病变,取宫颈异常部位的组织送病理;在血管丰富的区域未见醋白上皮出现,并不能排除宫颈病变,可以借助宫颈脱落细胞诊断结果,细胞学诊断提示异常则在红色区域连续取活检,包括颈管内的红色区域实施宫颈管搔刮术.妇产科医生遵循上述宫颈癌筛查三步流程,简易、准确并快速发现子宫颈癌和宫颈癌前病变,完成宫颈癌筛查的目标.

abstractsCervical cancer is the second leading cause of death due to gynecological malignancy in female patients. If obstetrician and gynecologists could master the mechanisms involved in the development of cell mutation and new tissue, the effectiveness of cervical cancer screening could be greatly increased. In the process of cervical cancer screening, if cervical tissue hyperplasia accompanied by bleeding could be identified by visual inspection and also in line with the conditions of abnormal cells and vascular proliferation, the cervical cancer would be highly suspicious at this time. Taking the tissue of the abnormal part of the cervix should be immediately conducted when conditions are available. If not, the colposcopy and following biopsy should be immediately performed. After these actions, if no cervical abnormalities are found, the visual inspection of cervix should be performed using cervical cytology (Pap smear test) or a human papillomavirus (HPV) test, or a combination of two tests. When the risk of cervical precancerous lesions predicted by screening results is greater than 5%, colposcopy should be required which is unconditional on the screening methods used before. In the area of abnormal cell proliferation and angiogenesis, 5% acetic acid should be applied to observe whether there is acetowhite epithelium. If yes, the cervical precancerous lesions is highly suspicious in the area of acetowhite epithelium and biopsy should be performed. Even if there is no acetowhite epithelium in the blood vessel?rich area, cervical precancerous lesion could not be excluded and the cervical detachment cell diagnosis results could be used. If the results prompt abnormalities, biopsy could be taken continuously in the red area, including the endocervical curettage in the red area of endocervical tissue. Following the above three?step process of cervical cancer screening, obstetricians and gynecologists could easily, accurately and quickly detect the cervical cancer and cervical precancerous lesions, and complete the goal of cervical cancer screening.