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[目的]研究改良的宫颈肉眼醋酸试验方法用于宫颈癌初筛并评价效果。[方法]采取整群随机抽样方法获得深圳市福田区教育局和宝安区观澜街道社区样本人群。采用肉眼醋酸试验方法(VIA)和改良肉眼醋酸试验(VIAM)方法进行宫颈癌筛查,异常者转诊阴道镜,病理诊断为金标准。采用转诊率、活检并发症发生率、检出率、早诊率和病理诊断相符率进行比较。[结果]深圳市福田教育局人群用肉眼醋酸试验方法(VIA)筛查1736例,阳性193例,转诊率11.12%;观澜街道人群用改良肉眼醋酸试验方法(VIAM)筛查1826例,阳性116例,转诊率6.35%,两者相比差异有显著性(χ2=25.50,P<0.01)。VIA方法活检出血6例,占3.11%,VIAM方法活检出血2例,占1.72%,两者相比,差异无统计学意义。VIA方法筛查,病理诊断相符率9.33%;VIAM方法筛查,质量控制后病理诊断相符率17.24%,两者相比差异有显著意义(χ2=4.2,P=0.04),其中21例初筛阴性质量控制后阳性病例,经病理诊断检出≥CINⅡ6例。[结论]肉眼醋酸试验需要建立有效的质量控制方法,使用改良的肉眼醋酸试验方法降低了转诊率并有效防止漏诊。筛查质量控制是宫颈癌早诊早治的重要保证。
[Objective] To study the modified cervical macroscopic acetic acid test method for cervical cancer screening and evaluate the effect. [Methods] The cluster random sampling method was used to obtain the community sample of Futian District Education Bureau and Guanlan Street community in Bao’an District. Cervical cancer screening was performed with the VIA and VIAM methods. The abnormalities were referred to the colposcopy and the pathological diagnosis was the gold standard. The rate of referral, the incidence of biopsy complications, the detection rate, the rate of early diagnosis and pathological diagnosis were compared. [Results] A total of 1736 cases were screened by VIA, 193 cases were positive, the referral rate was 11.12%. The population of Guanlan Street was screened by modified amyl acetate test (VIAM) for 1826 cases, 116 cases, the referral rate was 6.35%, the difference was significant (χ2 = 25.50, P <0.01). VIA biopsy in 6 cases, accounting for 3.11%, VIAM biopsy in 2 cases, accounting for 1.72%, the difference between the two was not statistically significant. VIA method screening, pathological diagnosis coincidence rate of 9.33%; VIAM screening, quality control pathological diagnosis consistent rate of 17.24%, there was significant difference between the two (χ2 = 4.2, P = 0.04), 21 of which screening Negative quality control positive cases, the pathological diagnosis of ≥ CIN Ⅱ 6 cases. [Conclusion] Macroscopic acetic acid test need to establish an effective quality control method, using the modified acetic acid test method to reduce the referral rate and effectively prevent missed diagnosis. Screening quality control is an important guarantee for early diagnosis and treatment of cervical cancer.