科普做试管婴儿前需要常规做宫颈癌筛查吗

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试管婴儿是体外受精一胚胎移植技术的俗称，是分别将卵子和精子取出后，置于培养液内使其受精，再将胚胎移植回母体子宫内发育成胎儿的过程。

体外受精胚胎移植技术的出现为一些难治性不孕的成功治疗提供了可能。但从上述定义可以看出，试管婴儿技术胚胎发育生长的过程，也就是常说的“怀胎十月”，最终还是要在妈妈的子宫内完成。

因此，做试管婴儿和正常妊娠样，都需要进行常规孕前查体，包括血常规、白带常规、盆部B超、子宫颈癌筛查、优生四项等。也就是说，做试管婴儿前需要常规做子宫颈癌筛查。

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近10多年来，我国妇女结婚和生育年龄逐渐后移，越来越多的妇女在30多岁甚至35岁以后才开始要孩子；近年来，随着我国二孩政策的放开，许多35岁以上的大龄妇女也希望生二胎，这些妇女其中一部分需要通过试管婴儿等辅助生育技术才能怀孕，这些妇女的生殖健康已经成为严峻的医学和社会问题。

因为35岁以上妊娠妇女就属于高龄产妇，不仅产科并发症及合并症增多，子宫颈癌及癌前病变的发生率也明显增加。因此，这些做试管婴儿的妇女在怀孕前更需要常规进行宫颈癌筛查。

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宫颈癌筛查的方法主要有人乳头瘤病毒(HPV)检测，子宫颈细胞学检查TCT(包括子宫颈巴士涂片和液基细胞学检查)，醋酸试验/复方碘试验肉眼观察(VIA/VILI)。目前国内外公认的子宫颈癌筛查最好方法是高危型人乳头瘤病毒(HPV)和液基细胞学（TCT）的联合筛查。

宫颈癌的发病率高居中国女性肿瘤第二位，仅次于乳腺癌,有“红颜杀手”的称号。我国宫颈癌每年新发病例近10万例死亡人数约3万例,相当于每天有约80名女性因宫颈癌去世。感染高危对象为已婚或有性生活史3年的女性。因此,即使不光是为了怀宝宝，定期筛查的意义对于女性来说十分重大。

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筛查建议:

（1）21~29岁采用宫颈细胞学检查,每2~3年1次。

（2）30~65岁采用宫颈细胞学检查每3年1次;或者HPV与宫颈细胞学联合筛查.每5年1次。

（3）筛查结束时间:大于65岁且既往多次检查均为阴性的,不需再筛查若曾诊断为高度鳞状上皮内病变(HSIL)病史者，再持续筛查20年，筛查频率视病情定。

（4）接受过子宫全切术的女性(无宫颈)且过去20年里未患有CIN2、CIN3,原位癌或癌症的女性不需要检查。

（5）接种过HPV疫苗的女性遵循特定年龄的建议(与未接种疫苗的女性一样)。

预防建议:1.接种HPV疫苗，2.不吸烟或戒烟，3.安全与健康性行为，4.及时治疗生殖道感染疾病，5.增强体质。

结合以上情况，首选推荐这些做试管婴儿的妇女采用TCT+HPV联合筛查方法，其次推荐HPV单独初筛方法。如果筛查无异常，可以放心的进行试管技术，如果筛查出现任何异常，应积极进行阴道镜检查等，排除子宫颈癌前病变和子宫颈癌后，才能进行试管婴儿技术。

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