多层螺旋CT对继发性附件扭转的综合评估

目的探讨继发性附件扭转的CT特征及其诊断效能,构建继发性附件扭转的评分系统。资料与方法收集经手术证实的伴有附件肿物的继发性附件扭转患者37例,以及伴有腹痛、附件肿物的对照组患者34例,分析继发性附件扭转的CT特征,采用受试者工作特征(ROC)曲线评价其诊断效能,构建继发性附件扭转的综合评分系统(AT-CI)。结果与对照组比较,继发性附件扭转以下CT特征发生率较高,包括肿物壁偏心性增厚(X^2=4.41,P<0.05)、附件出血(X^2=12.68,P<0.001)、肿物-子宫之间团块状结构(X^2=13.62,P<0.001)、旋涡征(X^2=10.71,P<0.05)、附件周围脂肪模糊/腹水(X^2=5.82,P<0.05)。其中肿物-子宫之间团块状结构敏感度及诊断价值最高,为81.1%(ROC曲线下面积0.71),旋涡征特异度最高,为91.2%。ATCI诊断效能优于任意单一CT特征(ROC曲线下面积0.83),评分0~2分继发性附件扭转可能性小,3~4分怀疑继发性附件扭转,评分>4分,则高度怀疑继发性附件扭转且特异度为100%。结论继发性附件扭转具有典型的CT特征,包括肿物壁偏心性增厚、附件出血、肿物-子宫之间团块状结构、旋涡征、肿物周围脂肪模糊/腹水。AT-CI是综合了继发性附件扭转全部CT特征的实用评分系统,提高了继发性附件扭转的诊断准确性。     

特殊部位异位妊娠的临床分析

目的探讨特殊部位异位妊娠的临床特点，误诊原因及治疗原则。方法对1996年1月至2003年12月诊治的256例特殊部位异位妊娠进行回顾性分析。结果特殊部位异位妊娠发生率占同期异位妊娠的3．36％，术前诊断率48．4％，所有的患者均行手术。视术中情况进行不同的处理，所得标本均经病理切片证实，全部患者愈后良好。结论特殊部位异位妊娠的临床表现不典型，容易漏诊误诊，一旦怀疑本病应尽早住院，及时明确诊断并手术，患者愈后良好。     

Sexual risk behavior in women with cervical human papillomavirus infection

In a study of 972 women, sexual characteristics of 66 women with a cervical human papillomavirus infection (CHPI) were compared to the remaining study population. Among a number of sexual variables that were significantly correlated with CHPI were number of lifetime sexual partners, short partnerships, many recent partners, infidelity, casual travel sex, sexual début abroad, oral and anal sex, and sexual abuse. In multifactorial analyses four variables remained significantly correlated with CHPI, i.e., number of lifetime sexual partners, casual travel sex, sexual début abroad, and infidelity. It is concluded that CHPI shows most of the epidemiological characteristics of a sexually transmitted disease.     

宫颈癌放疗后家庭阴道冲洗效果观察

目的:为寻找一种院外阴道冲洗的有效方法,从而帮助一些由于各种原因不能来医院行阴道冲洗术的患者继续完成治疗。方法:对204例宫颈癌放疗结束后的患者随机分实验组与对照组,实验组实施家庭阴道冲洗,对照组未行阴道冲洗,通过放疗结束后1个月、3个月、6个月门诊随访,观察阴道粘膜急性放射反应治疗后消退情况,对家庭阴道冲洗患者和未行阴道冲洗者进行对照研究。结果:行家庭阴道冲洗者在阴道粘膜急性放射反应方面与未冲洗者差异有显著性(P<0.05)。结论:家庭阴道冲洗是对因各种原因出院后不能来医院行阴道冲洗的患者可以采取的一种行之有效的方法。     

Ultrasonography in the detection of cervical incompetency

In 80 pregnancies with clinical and ultrasonic signs of cervical incompetency, the length of the cervix and the thickness of the anterior wall of a lower uterine segment have been evaluated ultrasonically. We have also measured the width of the endocervical canal and studied the prolapse of fetal membranes (with fetal parts) into the endocervical canal. We evaluated these same parameters in 80 healthy pregnancies. The length of the cervix, the thickness of the anterior wall of a lower uterine segment, and the width of the endocervical canal were followed longitudinally in the patients from the 10th to the 36th gestation week. No statistically significant differences between age groups were found. In four age groups at risk for cervical incompetency, cervical lengths and wall thickness were significantly different (p less than 0.001) from those in comparable controls. Forty-five percent of the patients in the at-risk group, with cervical cerclage, delivered at 37.3 (range: 32 to 41) weeks and 6.25% of pregnancies ended in abortion when the amniotic membrane herniated into the cervical canal, with or without some part of the fetus.     

颌面颈部恶性淋巴瘤临床分析

目的：总结口腔颌面颈部恶性淋巴瘤(ML)的诊断方法及治疗措施。方法：回顾性分析收治的ML患者38例的临床资料。结果：霍奇金病(HD)5例，非霍奇金淋巴瘤(NHL)33例，31例采用综合治疗，7例采用单纯化疗，38例1，3，5a生存者分别为5，14，12例，存活患者中以临床Ⅰ，Ⅱ期者占绝大多数，死亡患者中以Ⅳ期为多。结论：早期明确ML的诊断并早期治疗效果较好，综合治疗是最有效的治疗手段，临床分期对预后有重要参考价值。     

子宫阔韧带内静脉的解剖学研究及其临床意义

子宫底和体上部的静脉汇集于子宫角处浅出,应称子宫上静脉。该静脉续为卵巢静脉。子宫上静脉1条者占30%,2条者占56.7%,3条者占13.3%。子宫上静脉与输卵管峡部中点相对处的口径是3.7±0.2mm,卵巢丛与子宫上静脉汇合后的口径为5.0±0.4mm。输卵管峡部中点与子宫上静脉的间距为6.3±0.6mm。在输卵管系膜中见有输卵管静脉汇入子宫上静脉。本文研究结果认为盆腔静脉淤血症的发生,与结扎手术中损伤子宫上静脉和输卵管静脉有关。     

正丁醇提取的低分子量宫颈癌细胞表面抗原

本实验采用正丁醇提取方法以研究甲基胆蒽诱发的小鼠宫颈癌(U_(14))细胞表面抗原。用2.5%正丁醇溶液对U_(14)细胞进行提取所获得的正丁醇粗提物(CBE),经Lowry法测得其蛋白含量为147微克/毫升;在SDS-PAGE中显出8条区带,分子量为18-70kD;用ELISA检测表明CBE与抗宫颈癌单克隆抗体(AU_(14-1))和多克隆抗体均呈阳性反应。结果证明CBE系低分子量的宫颈癌细胞表面抗原,其中含有能够与AU_(14-1)发生免疫反应的肿瘤抗原决定簇。     

高危型人乳头状瘤病毒和宫颈细胞学联合检测在诊断宫颈病变中的临床价值

目的 探讨高危型人乳头状瘤病毒(hish-risk human papillomavirus,HR-HPV)和宫颈细胞学联合检测在诊断宫颈病变中的临床价值.方法 对2004年10月至2006年12月北京大学第一医院就诊的患者进行HR-HPV检测和宫颈细胞学检查,对一项或两项结果异常者均行阴道镜下宫颈活检,并以宫颈活检结果为金标准,比较HR-HPV检测、宫颈细胞学检查、HR-HPV和宫颈细胞学联合检测对宫颈病变的诊断价值.结果 HR-HPV检测、宫颈细胞学检查及HR-HPV检测联合宫颈细胞学检查对诊断宫颈病变有不同价值.HR-HPV检测筛查CINⅡ、CINⅢ的敏感度、特异度、阳性预测值和阴性预测值分别为94.83%、31.06%、55.22%、87.02%,宫颈细胞学筛查CINⅡ、CINⅢ的敏感度、特异度、阳性预测值和阴性预测值分别为92.10%、31.06%、54.50%、81.43%,HR-HPV和宫颈细胞学联合检测筛查CINⅡ、CINⅢ的敏感度、特异度、阳性预测值和阴性预测值分别为99.65%、18.55%、61.46%、97.62%.结论 采用HR-HPV和宫颈细胞学联合检测可提高宫颈病变的检出率,并可指导临床医生对宫颈病变的治疗.     

Tubal metaplasia: A cytologic study with comparison to other neoplastic and non-neoplastic conditions of the endocervix

Tubal metaplasia of the endocervix (TME), a condition that may be con/used morphologically with glandular neoplasia, is frequently found in cone or hysterectomy specimens. To determine the frequency of detecting TME in cytologic smears, we retrospectively reviewed 28 Papanicolaou (Pap) smears from 22 women (mean age 39.1 yr; range 25-60 yr) with histologically proven TME. Our criteria for TME were the presence of two cell types in addition to endocervical secretory cells, i.e., peg cells (cells with dark and granular cytoplasm and elongate nuclei) and ciliated cells. All women had cervical cytology specimens obtained with an endocervical brush shortly before the procedures in which TME was diagnosed, and five also had at least one post-procedure smear. Of 20 smears with an adequate, non-neoplastic endocervical component, TME was found in 2 (10%). In these two, TME cells constituted 10% and < 5% of all the glandular cells, respectively, and the percentage of ciliated cells in the TME was approximately 25% and 75%. In conclusion, TME was noted infrequently (10%) on the cervical cytosmears of women with histologically-proven TME. This result corresponds to the histologic finding that TME typically involves the upper endocervix and glandular epithelium, with only 13% of the women having TME on the surface of the lower endocervix. Atypical glandular cells on cervical cytology are a problem for clinicians and pathologists alike. The differential diagnosis of such atypia, including TME, cells of the lower uterine segment, squamous intraepithelial lesion in glands and glandular neoplasia, is discussed.