阴道镜检查在宫颈病变筛查中的应用价值

目的 分析在宫颈病变筛查中应用阴道镜检查的临床价值。方法 选取符合阴道镜检查指征的200例疑似宫颈病变患者,患者均接受阴道镜检查+活检,以病理诊断结果为金标准,评估阴道镜检查的诊断符合率。结果 200例患者经病理确诊炎症121例,CINⅠ级52例,CINⅡ～Ⅲ级24例,宫颈癌3例,阴道镜检查符合率分别为77.69%、86.54%、79.17%、100%,总符合率为80.50%。与病理诊断结果相比,阴道镜诊断宫颈炎症符合率差异有统计学意义（P<0.05）,但对CINⅠ级、CINⅡ～Ⅲ级及宫颈癌的诊断符合率比较,差异无统计学意义（P>0.05）。结论 阴道镜检查在宫颈疾病筛查诊断中,尤以宫颈癌、CIN的诊断效果较好,可作为宫颈病变早期筛查诊断的参考依据。     

阴道镜筛查宫颈病变6051例临床分析

目的探讨阴道镜检查对宫颈病变的诊断价值。方法2003年2月至2005年2月佛山市妇幼保健院采用电子阴道镜对6051例妇女进行阴道镜检查,其中1511例在阴道镜下定点活检送病理。结果经病理确诊宫颈上皮内瘤变(CIN)696例,包括CINⅠ543例、CINⅡ100例、CINⅢ53例,宫颈癌24例,活检CIN检出率46.06%。CIN发病年龄在20～39岁之间的病例占87.50%。宫颈癌的好发年龄为30～49岁,占宫颈癌总数的95.83%。宫颈轻度糜烂患者占发生CIN总数的30.17%,其中CINⅡ、CINⅢ分别占30.00%和37.74%,宫颈光滑者占CIN总数的8.33%。结论采用阴道镜检查能及早发现宫颈癌前病变,是宫颈癌筛查方便安全、准确可靠的检查方法。     

TCT和阴道镜与TCT、HPV和阴道镜在宫颈癌筛查中应用体会

目的:研究宫颈癌的早期筛查,观察不同筛查方法在宫颈癌早期筛查中的应用。方法:对2009年3月至2010年10在本医院妇科门诊前来体检和就诊的1216位妇女,采用TCT+阴道镜和TCT+HPV+阴道镜两种不同的方法进行宫颈癌筛查,最后以宫颈活检病理诊断为金标准,比较筛查效果。结果:A组596例采用TCT+阴道镜筛查,发现46例细胞学异常者行阴道镜下宫颈活检,结果慢性炎症28例,占4.69%,CINⅠ7例,占1.17%,CINⅡ8例,占1.34%,CINⅢ2例,占0.34%,原位癌1例,为0.17%;B组620例采用TCT+HPV+阴道镜筛查,发现TCT和HPV阳性者78例行阴道镜下宫颈活检,结果慢性炎症33例,占5.32%,CINⅠ21例,占3.39%,CINⅡ14例,为2.26%,CINⅢ9例,占1.46%,原位癌1例,为0.16%;TCT联合HPV检测筛查明显优于单次TCT的检查。体会:在宫颈癌早期筛查中TCT+HPV+阴道镜筛查方法优于TCT+阴道镜筛查方法,在门诊进行个体化筛查时值得推广。     

电子阴道镜检查诊断宫颈病变1324例临床分析

目的:探讨电子阴道镜检查在宫颈疾病诊断中的临床价值。方法:对1324例患者行阴道镜检查及病理检查并对结果进行分析。结果:电子阴道镜对慢性宫颈炎、宫颈息肉、尖锐湿疣、宫颈癌、CINⅠ、CINⅡ、CINⅢ的诊断与病理诊断符合率分别达94.19%、100%、91.67%、92.31%、91.93%、92.59%、74.07%.结论:电子阴道镜对宫颈痰病的诊断准确性高,尤其是对宫颈癌前病变和早期宫颈癌,是一种能对宫颈癌早发现、早诊断的辅助检查手段。     

260例电子阴道镜下图像特点与宫颈活检病理诊断的关系

目的:探讨电子阴道镜下的宫颈异常表现图像与宫颈活检病理诊断的相互关系。方法:选择2011年9～11月就诊于本院阴道镜门诊的260例患者,以活检病理学诊断结果为标准,对组织病理学结果和阴道镜表现特点进行分析。结果:①电子阴道镜在宫颈疾病诊断中敏感性97.9%,特异性71.2%,阳性预测值89.7%,假阴性率2.1%;②阴道镜下扁平醋白上皮可出现在宫颈炎到CINⅢ的各级宫颈病变中,致密醋白上皮出现于CINⅡ及以上级别的宫颈病变中。二联征中CIN的检出率为77.4%,三联征和醋白上皮+非典型血管中CINⅢ及宫颈癌(ICC)的检出率分别是78.6%和72.4%。③不典型鳞状上皮(ASC)和(或)非典型腺细胞(AGC)出现在各级宫颈病变,在低度鳞状上皮内瘤变(LSIL)中CINⅠ的检出率为40.9%,在高度鳞状上皮内瘤变(HSIL)(包括HSIL+AGC)中CINⅡ、CINⅢ及ICC的检出率为96.9%。④宫颈表面是否光滑及糜烂程度与宫颈自身病变无关。结论:电子阴道镜是辅助诊断宫颈疾病的可靠而重要的手段,典型的异常阴道镜图像对诊断宫颈癌前病变和宫颈癌有重要价值。     

宫颈环形电切除术治疗宫颈上皮内瘤变155例临床分析

目的:探讨宫颈环形电切除术(LEEP)治疗宫颈上皮内瘤变(CIN)的临床价值.方法:对经阴道镜下宫颈活检诊断为CIN的155例患者采用LEEP宫颈锥切,观察手术时间、出血量,比较术前宫颈活检与术后病理检查结果,随访疗效和宫颈塑形情况.结果:LEEP治疗CIN平均时间6.8分钟,出血量9.6 ml,阴道镜下宫颈活检的CIN Ⅰ、CIN Ⅱ、CIN Ⅲ与LEEP术后标本的病理诊断CIN Ⅰ、CIN Ⅱ、CINⅢ呈正相关,相关系数r_0=0.785(P<0.01),治愈率为98.7%(149/151),151例中宫颈塑形满意134例(88.7%).结论:LEEP是诊断和治疗CIN安全有效的方法.     

电子阴道镜诊断宫颈疾病660例临床分析

目的:探讨电子阴道镜检查在宫颈疾病诊断中的价值。方法:2010年5月至2011年4月对在徐州市云龙区妇幼保健所妇科门诊及体检的妇女中做阴道镜检查660人,并与组织病理学检查结果对照。结果:660例电子阴道镜检查中,对有可疑情况者325例取活检,根据活检结果确诊为慢性宫颈炎206例,子宫颈上皮内瘤样病变(CIN)Ⅰ-Ⅲ107例,宫颈癌3例,宫颈湿疣5例,正常宫颈4例。诊断正确率97.34%,假阳性率2.73%。结论:电子阴道镜对诊断阴道、宫颈病变具有重要价值,在电子阴道镜引导下取活检,对早期宫颈癌、癌前病变以及宫颈癌的诊断有重要价值,结合组织病理学检查可以提高诊断的准确率。     

阴道镜下宫颈活组织检查诊断孕妇宫颈病变的临床研究

目的 探讨阴道镜下官颈活组织检查(活检)诊断孕妇宫颈病变的临床价值和安全性.方法 采用队列研究方法,选择2007年8月1日至2009年2月28日在北京妇产医院产科门诊初次检查的孕13～34周、1年内未进行过宫颈液基薄层细胞学检查(TCT)的孕妇,先进行TCT筛查,对TCT结果异常者,在知情同意后进行阴道镜检查和阴道镜下宫颈活检.结果 (1)TCT:TCT筛查孕妇共计17 828例,其中TCT结果异常1502例,发生率为8.425%.(2)阴道镜检查:204例孕妇进行了阴道镜检查.阴道镜图像满意度为92.6%(189/204),阴道镜拟诊宫颈炎或宫颈上皮内瘤变(CIN)Ⅰ 125例,CIN Ⅱ25例,CIN Ⅲ或宫颈鳞状细胞癌(SCC)54例.(3)阴道镜下宫颈活检病理结果:204例行阴道镜检查者全部进行了宫颈活检,病理结果为宫颈炎及宫颈湿疣共33例,CIN Ⅰ 95例、CIN Ⅱ28例、CIN Ⅲ36例(包括官颈原位癌13例)、SCC Ⅰ a期12例.(4)符合度:与宫颈活检病理结果比较,阴道镜检查拟诊炎症和CIN Ⅰ 125例,其中113例与宫颈活检病理结果相同,符合率为90.4%(113/125),125例炎症和CIN Ⅰ患者中无一例病理结果为SCC.阴道镜检查拟诊CIN Ⅲ或SCC共54例中,23例活检病理结果为CIN Ⅲ、10例为SCC Ⅰ a期,符合率为61.1%(33/54例).(5)并发症:阴道镜检查及官颈活枪后,8例孕妇因官颈局部压迫止血无效行创面缝合止血,发生率3.9%(8/204),未发生其他与阴道镜检查和宫颈活检相关的不良事件.结论 对1年内未进行宫颈细胞学筛杏的孕妇进行TCT检查是必要的,对TCT结果异常者应进行阴道镜检查,阴道镜检查拟诊官颈炎或CIN Ⅰ者可以随诊,对阴道镜检查拟诊CIN Ⅱ及更高级别宫颈病变的孕妇,应行阴道镜下宫颈活检以明确病理学诊断.     

宫颈癌机会性筛查的应用与探讨

目的:探讨宫颈癌机会性筛查的应用及意义。方法:为2008年1月~12月在新疆自治区人民医院妇产科门诊就诊的患者行机会性筛查,以液基细胞学、HPV检测和阴道镜为筛查方法,活检组织病理学诊断为最终诊断标准,评价机会性筛查用于宫颈癌早诊、早治的意义。结果:4485例患者中一半以上患者不了解宫颈癌相关知识;患者筛查顺应性为98.79%(4431/4485),检出细胞学阳性569例,阳性检出率12.68%(569/4485);561例行高危HPV检测,感染率36.54%(205/561);549例行阴道镜+活检,活检病理结果为:CINⅠ62例,CINⅡ-Ⅲ46例、SCC 8例。2008年宫颈癌筛查参与率及宫颈病变检出率与2007年同期比较差异有统计学意义(P0.05)。结论:通过机会性筛查相关干预措施有助于提高患者对宫颈癌的认知程度,是全面防治宫颈癌的重要内容;机会性筛查顺应性好,能够早期发现宫颈病变,是行之有效的宫颈癌筛查方法,值得推广应用。     

190例宫颈上皮内瘤变的临床诊治分析

目的:探讨宫颈上皮内瘤变(CIN)的诊断及对治疗的影响。方法:对2003年在我院诊断为CIN的190例患者的术前宫颈多点活检、术中快速病理诊断、术后组织学结果及治疗方法等资料进行回顾性分析。结果:术前宫颈多点活检的过低诊断率为8.0%(肉眼下多点活检11.8%、阴道镜下多点活检2.2%),漏诊浸润癌3例;术中快速病理诊断后过低诊断率降至4.5%,无浸润癌漏诊。对CINⅠ和CINⅡ、Ⅲ的过度治疗率分别为21.7%和38.0%。结论:阴道镜下多点活检可以提高诊断准确性,术中宫颈锥切或再次多点活检行快速病理诊断可减少对宫颈癌及CIN的过低诊断,有利于选择恰当的治疗方法。     

Differences in female and male perception of information and decision-making in single-embryo transfer in in vitro fertilization in Sweden

Purpose The aim of this study was to evaluate the information and the factors that contribute to the decision to accept and choose single embryo transfer (SET) in females and males. Materials and methods Fifty-four females and males undergoing SET were interviewed separately using a structured questionnaire. Results The women were significantly more satisfied with the information than the men (odds ratio 3.3), but the decision to accept SET was nevertheless more difficult for women (OR 3.1). Only one-third of both female and males were aware of the increased maternal risks with twin pregnancies. There was a tendency that the women who accepted SET had previous children, shorter duration of infertility, and were younger. Cryopreservation of embryos and a good pregnancy chance were important irrespective of gender. Conclusion The female needs more support to choose SET. The male needs better information and further involvement in decision-making. The females were more aware of the fetal risks, but the awareness of the increased maternal risks with twin pregnancies was low. The female need more support to accept and choose single embryo transfer, compared to the male and information should in some areas be directed differently to females and males.     

Ovulation induction in in vitro fertilization

The main goal of an in vitro fertilization (IVF) program is to maximize the number of women who become pregnant in any treatment cycle. In order to achieve pregnancy, many steps should be successfully accomplished. The number of mature oocytes that are retrieved and fertilized in a treatment cycle has the major impact on the success rate of the IVF program. The chances of achieving conception increases dramatically when the number of embryos replaced into the uterus increases^1-3. Hence, most IVF treatment programs currently use some combination of ovulation induction agents in order to stimulate and aspirate as many follicles as possible.     

Non-persistent pesticides in breast milk in an agricultural area in Turkey

Background: Organophosphates, pythyreoids, carbamate pesticides and fungicides are heavily used in agriculture. They may have dangerous effects on newborn health especially on immune system and growth via prenatal transmission by placenta or postnatal transmission by breastfeeding.

Methods: In 2015, 144 non-persistent pesticides in 64 milk samples of 32 mothers were studied by OuEChERS method in liquid chromatography/tandem mass spectrometer in neonatal Intensive Care Unit in Adana, a city in Cukurova region which is an important agricultural area in Turkey.

Results: Pesticides were detected in milk samples of 11 mothers (34.3%) and 21 (32.8%) of milk samples. In five mothers, fungicides (in 5/10 samples propicanozole-PP, in 4/10 samples bromucanozole-BM), in five mothers, organophosphates (in 10/10 samples primyphosphomethyl-PPM), in one mother, both organophosphates and fungicide (in 1/2 samples PPM and in 1/2 samples buprimate) were detected. However, the estimated daily intakes (EDI) were less than acceptable daily intakes (ADI) for PPM, PP and BM, respectively.

Conclusions: Although pesticides levels in human milk did not exceed the ADIs, we suggest monitoring pesticides in human breast milk especially for newborn health.     

Heterogeneity in alpha-thalassemia interactions in Malays, Chinese and Indians in Malaysia

AIM: Interactions between different determinants of alpha-thalassemia raises considerable problems, particularly during pregnancies where antenatal diagnosis is necessary. This study aims to determine the different types of deletional alpha-thalassemia and Hemoglobin Constant Spring (HbCS), and their frequency in Malays, Chinese and Indians in Malaysia. METHODS: DNA from 650 pregnant women from the Antenatal Clinic of the University of Malaya Medical Center in Kuala Lumpur, Malaysia who showed mean cell volume < or =89 fL and/or mean cell hemoglobin < or =28 pg were analyzed for the double alpha-globin gene South-East Asian deletion (--SEA), the -alpha3.7 and -alpha4.2 single alpha-globin gene deletions and HbCS. RESULTS: One hundred and three (15.8%) of the pregnant women were confirmed as alpha-thalassemia carriers: 25 (3.8%) were alpha-thalassemia-1 carriers with the --SEA/alphaalpha genotype, 64 (9.8%) were heterozygous for the -alpha3.7 rightward deletion (-alpha3.7/alphaalpha), four (0.6%) were heterozygous for the -alpha4.2 leftward deletion (-alpha4.2/alphaalpha), nine (1.4%) were heterozygous for HbCS (alphaCSalpha/alphaalpha) and one (0.2%) was compound heterozygous with the -alpha3.7/alphaCSalpha genotype. The double alpha-globin gene --SEA deletion was significantly higher in the Chinese (15%) compared to the Malays (2.5%) and not detected in the Indians studied. The -alpha3.7 deletion was distributed equally in the three races. HbCS and -alpha4.2 was observed only in the Malays. CONCLUSION: The data obtained gives a better understanding of the interactions of the different alpha-thalassemia determinants in the different ethnic groups, thus enabling more rapid and specific confirmation of alpha-thalassemia in affected pregnancies where antenatal diagnosis is necessary.