CO2激光治疗宫颈上皮内瘤变和阴道上皮内瘤变临床疗效

目的探讨CO₂激光治疗宫颈上皮内瘤变(CIN)和阴道上皮内瘤变(VaIN)的临床疗效。 方法选取2016年1～12月,在上海交通大学医学院附属国际和平妇幼保健院进行CO₂激光治疗的607例CIN和(或)VaIN患者为研究对象。其中,单纯CIN为451例(74.3%),单纯VaIN为104例(17.1%),CIN合并VaIN为52例(8.6%)。采用成组t检验,对不同类型患者年龄等进行统计学比较。采用χ²检验,对不同类型患者宫颈环形电切术(LEEP)史发生率及CO₂激光治疗部位、CO₂激光治疗次数构成比等,进行统计学比较。采用非条件多因素logistic回归分析,对患者接受CO₂激光治疗后,人乳头瘤病毒(HPV)转阴及病理级别降低影响因素进行分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。 结果①本组607例患者中,CO₂激光治疗总有效率为95.4%(579/607),疾病复发率为4.6%(28/607)。其中,单纯CIN、单纯VaIN、CIN合并VaIN患者的CO₂激光治疗有效率,分别为95.3%(430/451)、98.1%(102/104)与90.4%(47/52)。②本组607例患者接受CO₂激光治疗后,HPV转阴率为74.1%(450/607)。其中,单纯CIN、单纯VaIN、CIN合并VaIN患者的HPV转阴率分别为80.0%(361/451)、54.8%(57/104)与61.5%(32/52)。③多因素非条件logistic回归分析结果显示,LEEP史(OR＝0.500,95%CI：0.273～0.915,P＝0.025)为CIN和(或)VaIN患者接受CO₂激光治疗后2年,HPV转阴的独立影响因素。④本组607例患者接受CO₂激光治疗后,病理级别降低率为93.7%(569/607)。其中,单纯CIN、单纯VaIN、CIN合并VaIN患者的病理级别降低率,分别为93.6%(422/451)、98.1%(102/104)与86.5%(45/52)。多因素非条件logistic回归分析结果显示,CO₂激光治疗部位为宫颈＋阴道(OR＝11.727,95%CI：1.337～102.859,P＝0.026)是CIN和(或)VaIN患者接受CO₂激光治疗后2年,病理级别降低的独立影响因素。 结论CO₂激光治疗CIN和(或)VaIN有效。CIN和(或)VaIN患者接受CO₂激光治疗后,HPV转阴、病理级别降低受不同因素影响。     

临床沙眼衣原体分离培养与鉴定方法的比较

目的 探讨从临床病人中，分离培养沙眼衣原体的标本采集、去杂菌污染，比较接种及沙眼衣原体鉴定的方法。方法 随机取100例门诊女性标本，在McCoy细胞中进行分离培养沙眼衣原体，比较新鲜标本及运送培养基中4℃过夜后去杂菌的差别；比较离心法与聚己二醇法接种对分离的影响；比较染色和膜免疫层析法对沙眼衣原体的鉴定。结果 分离到沙眼衣原体9株。标本经运送培养基中4℃过夜后杂菌污染下降2倍；离心法及聚己二醇法接种沙眼衣原体的分离率无明显差异；膜免疫层析法对沙眼衣原体的鉴定较染色法简便，快速。结论 标本应4℃过夜后接种以降低污染率：较离心法简便的聚己二醇法可用于沙眼衣原体的培养及传代；膜免疫层析法对沙眼衣原体的鉴定快速方便，但成本较高。     

高级别宫颈鳞状上皮内病变LEEP术后病理升降级的相关因素分析

Objective?To investigate the related factors of pathological changes after loop electrosurgical excision procedure (LEEP) in patients with high-grade squamous intraepithelial lesion (HSIL). Methods?The clinical data of 449 patients with HSIL diagnosed by cervical biopsy under colposcopy and treated by LEEP in the International Peace Maternal and Child Health Hospital Affiliated to Shanghai Jiaotong University from January 2019 to June 2020 were retrospectively analyzed.The relationship between the related factors and postoperative pathology was compared. Results?① The rate of pathological degradation was 24.5% (63/257) and 16.1% (31/192) ,the upgrade rate was 5.8% (15/257) and 15.1% (29/192) at age <40 years and ≥40 years, respectively, the differences between the two groups were statistically significant (P<0.05).② There was statistical difference between hPV16/18 positive group and HPV16/18 negative group (P<0.01).③ About the TCT results, 14 cases (5.3%), 166 cases (63.1%) and 83 cases (31.6%) of NILM/ASC-US/LSIL group had pathological upgrade, coincidence and degradation, respectively. There were 30 cases (16.1%), 145 cases (78.0%) and 11 cases (5.9%) in HSIL/ASC-H/AGC group, respectively, and the difference was statistically significant (P<0.01).④ In colposcopy images, there were statistically significant differences according to the maximum diameter line of lesions, lesion location, SCJ visibility and atypical vessels (P<0.05).⑤ The  maximum diameter of the lesion, the location of the lesion, the presence or absence of atypical vessels and the visibility of SCJ under colposcopy, were the independent influencing factors for predicting the postoperative pathological upgrading (P<0.05); TCT results, HPV16/18 infection and lesion location were independent influencing factors for predicting postoperative pathological downgrading(P<0.05). Conclusions?Comprehensive evaluation of colposcopic images, TCT and HPV results before LEEP is of great significance for the selection of treatment options.     

阴道镜检查在外阴尖锐湿疣合并宫颈尖锐湿疣中的诊断价值

目的:在外阴尖锐湿疣(condylom ata acum inata,CA)的患者中开展阴道镜检查的作用及意义。方法:外阴CA患者均行宫颈细胞学检查及了解自觉症状,并行阴道镜检查。结果:97例行阴道镜检查的外阴CA患者中,39例阴道镜下活检病理诊断宫颈湿疣,其中25例巴氏Ⅰ级中发现,检出率30.9%;3例巴氏Ⅱ级中发现,检出率60.0%;11例从巴氏Ⅲ级中发现,检出率100%。有分泌物增多及接触性出血、无分泌物增多而仅有接触性出血和无任何临床症状的宫颈CA检出率分别为47.6%、61.0%和31.0%。结论:外阴CA的患者合并宫颈CA比例较高,故外阴CA患者有必要行阴道镜检查。