适宜农村地区子宫颈癌筛查方法的研究

目的探索适合宫颈癌高发且经济欠发达地区子宫颈癌及其癌前病变的筛查方法,以最终降低子宫颈癌的发病率和死亡率。方法以山西省襄垣县下良乡35￣55岁的妇女作为对象,进行以人群为基础的宫颈癌筛查。对符合条件的妇女进行危险因素、癌症及子宫颈癌认知情况的问卷调查,用醋酸染色后肉眼观察(VIA)和碘染色后肉眼观察(VILI)进行宫颈检查,结果异常者进行阴道镜下活组织检查并得到最终的病理学诊断。将该次筛查对不同级别病变的检出率与历年来的襄垣地区的筛查结果进行比较。结果该次筛查人群参与率为74.8%。患宫颈糜烂和滴虫感染的妇女分别占受检人群的48.3%和14.8%。最终经活检病理确诊的CINⅠ的现患率为0.8%(10例)、CINⅡ0.7%(9例)、CINⅢ1.1%(13例)、子宫颈癌0.2%(3例)。该次单纯肉眼观察对CINⅡ和对≥CINⅢ病变的检出率略低于已往当地普查项目,但差别无统计学意义。结论在资源有限,经济不发达的农村地区,由经过培训的医生进行肉眼观察的宫颈癌筛查是可行的,单纯肉眼观察是一种经济有效的筛查方法,建议进一步在农村地区进行推广。     

说说你的新家规

“家规”这个字眼似乎有点严肃，联想起古代的“三从四德”，令人不禁感到压抑。其实不然，现代家庭在遵循夫妻平等的原则下，自然也需要一些彼此默许的规则。     

点刺深透治疗漏肩风93例疗效观察

目的：探讨点刺深透治疗漏肩风的疗效。方法：将126例患者随机分为治疗组和对照组,对照组33例,治疗组93例,点刺络穴、深透穴位配合TDP红外线治疗肩周炎,两个疗程后观察疗效。结果：治疗组有效率为100%,对照组有效率为90.91%。结论：点刺络穴、深透穴位对治疗肩周炎起到了标本兼治的功效。     

城市和农村妇女高危型人乳头瘤病毒感染的危险因素分析

目的:探讨影响我国城市和农村地区高危型人乳头瘤病毒(HR-HPV)感染的危险因素,为HR-HPV感染和子宫颈癌的防治工作提供依据。方法:采用横断面调查方法对城市地区(北京和上海)1 569人、农村地区(山西和河南)1 763人进行流行病学调查和妇科检查及高危型人乳头瘤病毒检测(HC-Ⅱ)。利用χ2检验和非条件Logistic回归模型分析HR-HPV感染的危险因素。结果:多因素分析结果显示,影响城市地区HR-HPV感染的危险因素为丈夫婚外性行为、生殖器感染史(STD)、流产次数和吸烟,而细胞学检查史是保护因素。影响农村地区HR-HPV感染的危险因素为初次性交年龄、近5年性伴侣数、丈夫婚外性行为、性生活年限和饮酒。结论:影响城市与农村地区妇女感染HR-HPV的危险因素存在着较大差异。提示,在制定预防和控制宫颈癌以及HR-HPV感染的措施时要因地制宜。     

宫颈癌即时筛查技术效果评价

目的:分析即时检测（POCT）技术筛查宫颈癌及癌前病变的准确性。方法:2020年9月,在山西省襄垣县建立的“自我采样”队列和“医生采样”队列中,采用简单随机抽样的方法从两队列人群中抽取研究对象,分别纳入197和273名。由研究对象自己或妇科医生分别采集宫颈脱落细胞标本并进行检测,采用POCT检测人乳头状瘤病毒（HPV）...     

刺络放血加电针治疗中老年骨性关节炎60例报告

目的讨论刺络放血加电针治疗中老年骨性关节的疗效。方法治疗组和对照组患者均以穴位针刺加电针为基础治疗,治疗组加电针刺放血疗法。结果用刺络放血疗法治疗总有效率97．29％,对照组总有效率83．34％,治疗组优胜于对照组。结论刺络放血加电针治疗中老年骨性关节炎起到了标本兼治的功效。     

醋酸白及碘试验肉眼观察法在农村妇女宫颈癌筛查中的作用

目的探讨醋酸白及碘试验肉眼观察法在宫颈癌筛查中的意义。方法 2008年3月至10月应用醋酸白及碘试验肉眼观察法(VIA/VILI)对华北地区6县市(北京大兴区、天津大港区、河北赤城和曲周、山西襄垣和沁县)6地区部分生育年龄农村妇女进行宫颈癌筛查,对阳性者行阴道镜检查,如异常取活检病理学检查,确诊病变者依据早诊早治技术方案进行治疗。结果 6地区共筛查12208例,大兴、大港、赤城、曲周、襄垣、沁县:VIA/VILI阳性率分别为11.50%、17.95%、21.88%、6.19%、2.95%、6.11%;阴道镜检查的活检率分别为80.43%、83.33%、8.26%、48.00%、100.00%、74.40%;活检病例中宫颈高度以上病变所占比例分别为6.49%、15.67%、18.42%、1.67%、18.33%、21.51%;VIA/VILI对宫颈高度以上病变检出率分别为5.22%、13.06%、1.52%、0.80%、18.33%、16.00%。结论不同地区醋酸白及碘试验肉眼观察法在应用和推广中存在一定的局限性,应予以重视。     

宫颈癌多种筛查方案的研究

Objective To assess the feasibility and accuracy of different cervical cancer screening algorithms suitable for different regions, and promote the prevention and control of cervical cancer in China. Methods Using the data of a cross-sectional comparative trial of multiple techniques to detect cervical intraepithelial neoplasia in Xiangyuan County, Shanxi Province, conducted in 1999, to evaluate the feasibility and accuracy of different cervical cancer screening algorithms. All the women were screened by six screening tests, including liquid based cytology ( LBC) , fluorescence spectroscopy, visual inspection with 5% acetic acid staining (VIA) , colposcopy, self-sampled HPV DNA and clinician-sampled HPV DNA test, and each woman had histopathological diagnosis. Different screening algorithms were developed by combining the screening tests in parallel or in serial, and the performance indexes of the algorithms such as sensitivity, specificity, colposcopy referral rate and receiver operating characteristic ( ROC ) curve for detecting the high grade lesions ( ≥CIN 2) were compared. Results Among the algorithms combined by LBC and HPV DNA testing, for the combination in parallel (either cytology was greater than ASC-US or HPV positives) , its sensitivity was 100% , specificity was 68.6% , and colposcopy referral rate was 34.4% ; for the algorithm of LBC as primary screening test, with ASC-US women triage by HPV DNA testing, its sensitivity was 93.0% , specificity was 89.9% , and colposcopy referral rate was 13. 7% ;for the algorithm of HPV DNA testing as the primary screening test, with HPV positive women triage by LBC, its sensitivity was 91. 7% , specificity was 93. 0% , and colposcopy referral rate was 10. 6%. ROC analysis showed that LBC primary testing followed by HPV triage and HPV primary testing followed by LBC triage were much better than the combination in parallel (P =0.0003, P= 0.0002). Among the algorithms with LBC or HPV DNA testing solely as primary screening test, the sensitivity, specificity and colposcopy referral rate of LBC were 94.2% , 77.3% , 25. 7% and 87. 2% , 93. 5% , 10. 0% , respectively, for cutoff by ASC-US or by LSIL; the sensitivity, specificity and colposcopy referral rate of HPV DNA testing were 97.6% , 84. 8% , 18.8% and 83.5% , 85. 9% , 17. 1% , respectively, for clinician-sampled and self-sampled. Clinician-sampled HPV DNA testing was better than LBC cutoff by ASC-US or self-sampled HPV DNA testing ( P = 0. 005, P = 0.002). Among the algorithms combined by VIA and HPV DNA testing, the sensitivity, specificity and colposcopy referral rate were 70. 9% , 74. 3% and 27. 6% for VIA alone as primary screening test; the sensitivity, specificity and colposcopy referral rate were 65. 9% , 95. 2% and 7. 4% for HPV as primary screening test with HPV positive women triage by VIA. HPV primary testing followed by VIA triage was better than VIA alone (P =0. 004). Conclusion Considering the health-resource settings and women's preference, both HPV primary testing followed by LBC triage and LBC primary testing followed by HPV triage are suitable for developed regions, moderately developed regions may choose either LBC or HPV as the screening approach, VIA is a suitable primary screening test in less developed regions, and HPV primary testing followed by VIA triage will be more effective if low cost HPV test is available in the future.     

山西省襄垣县宫颈癌和乳腺癌联合筛查效果初探

目的 通过分析为国家宫颈癌和乳腺癌筛查提供基本评价数据.方法 2009～2010年山西省襄垣县妇幼保健院对该县30～59岁妇女通过醋酸/碘染色后肉眼观察方法开展宫颈癌筛查,阳性者转诊阴道镜,镜下有病变时取活检,以病理诊断为金标准.对35～59岁的妇女开展乳腺癌筛查,以临床检查法为初筛方法,怀疑阳性者通过超声或乳腺X线进行诊断.结果 2009年完成1993名妇女的宫颈癌筛查,其中宫颈上皮内瘤变2级(CIN2)及以上病变的患病率为1.6%,早诊率为100%,第2年复查率为91%,仅查出1例CIN2,未查出更高病变,早诊率达100%.完成1819名妇女的乳腺癌筛查,乳腺良性病变9例(4.02%),良性肿瘤3例(1.34%);2010年完成2026名妇女的乳腺癌筛查,良性病变103例(13.57%),良性肿瘤14例(1.84%),可疑恶性1例.结论 该县宫颈癌的筛查效果明显,乳腺癌筛查仍需加强技术培训.筛查体系和技术队伍建设是基层单位承担农村妇女健康保健服务的关键.