婦科良性疾病施行全子宮切除術後陰道抹片之追蹤

Vaginal Pap Smear in Women Status-post Total Hysterectomy for Benign Disease

在台灣，當我們推廣子宮頸抹片檢查服務時，往往不會事先詢問婦女的子宮是否已經切除。因此，本研究是想來探討因婦科良性疾病切除全子宮之婦女，其陰道抹片發生陽性的機率，以評估此族群婦女是否有繼續每年追蹤抹片之必要。我們收集2002 年到2011 年在嘉義基督教醫院檢查的抹片數據，共有467796 筆，並根據相關的病理結果進行分析。「不正常的抹片結果」定義為「ASC-H，AGC-FN，LSIL，HSIL，AIS 和癌症（cancer）」。抹片陽性率則是計算這些婦女不正常抹片結果的比例。所得數據以SAS 9.2軟體進行分析。研究結果發現：因婦科良性疾病切除全子宮之婦女其陰道抹片陽性率為0.7％，其中術後第一次陰道抹片檢查就呈現異常者佔0.64％，而依年齡進一步分析，發現陽性率會隨著年齡增長而增加，其中多分佈在大於80 歲的婦女（1.9％），而婦女因婦科良性疾病切除子宮後陰道抹片的陽性率為0.7％，低於一般婦女的1.1％。因此，在我們推廣子宮頸抹片檢查的同時，需考慮此族群陰道抹片追蹤的必要，並把年齡因素納入執行陰道抹片追蹤的考量。

In Taiwan, annual Pap test has been promoted for years regardless of existence of uterine cervix or not. To assess the difference, we tried to collect and analyze the Pap test data in women status-post hysterectomy for benign disease in a teaching hospital in Southern Taiwan. Pap test data in Chia-Yi Christian Hospital, Chia-Yi City, Taiwan from 2002 to 2011, totally 467796 Pap tests were enrolled. Of these, total number of vaginal Pap test from women above 30 years old was 32129. That in women older than 30 and status-post hysterectomy for benign disease was 27037(14132 persons). Data was analyzed using statistical software SAS 9.2. Abnormal smear includes ASC-H, AGC-FN, LSIL, HSIL, AIS, and CANCER. The positive rates of vaginal smear in women older than 30 and status-post hysterectomy for benign disease were calculated. And its relationship to age was further analyzed. The positive (abnormal) rate was 0.7% (184 records).The positive rate of first vaginal Pap test post hysterectomy was 0.64%. The positive rate increased as age growing. The highest was in the group aged older than 80y/o (1.9%). The positive rate of vaginal Pap test in women status-post hysterectomy for benign disease was lower than that in women with uterine cervix. (0.7% vs. 1.1%). These data could be as reference for further vaginal Pap test in women status-post hysterectomy for benign disease or not, considering the age factor. Key Words: Vaginal Pap test, post hysterectomy, benign gynecologic disease