宫颈癌患者术后尿失禁发生情况及相关危险因素分析

目的 探讨宫颈癌患者术后尿失禁发生情况及相关危险因素。方法 选择69例宫颈癌患者，收集所有患者临床资料，依据患者是否存在术后尿失禁，将患者分为发生组(38例)及未发生组(31例)。分析影响宫颈癌患者术后尿失禁发生的相关影响因素。结果 发生组年龄≥45岁、肿瘤直径≥4 cm、已绝经、留置导尿管时间≥7 d发生率均高于未发生组，差异有统计学意义(P<0.05);年龄、肿瘤直径、绝经、留置导尿管时间是宫颈癌患者术后发生尿失禁的独立危险因素(OR值≥1,且P<0.05)。结论 术前应加强对年龄、绝经女性筛查，对于肿瘤直径较大的患者，需注意术中切除范围，术后尽早下床活动，缩短导尿管留置时间，有利于降低术后尿失禁发病率，提升患者生活质量。     

宫颈癌全子宫切除术与盆底功能障碍性疾病的关系

目的探讨宫颈癌全子宫切除术后盆底功能障碍性疾病的发生情况。方法选取实施全子宫切除手术的97例宫颈癌患者,其中45例患者仅采用单一全子宫切除术加盆腔淋巴结清扫术(手术组),52例患者采用手术治疗联合放射治疗(联合组),计算两组患者术后排尿系统压力评测(UDI)和排便系统压力评测(DDI)评分,分析盆底功能障碍性疾病发生的危险因素。结果 UDI和DDI中,联合组患者UDI所有项目和DDI中腹泻发生率明显高于手术组患者,差异有统计学意义(P<0.05)。UDI中,两组患者尿急、尿失禁、排尿困难症状评分与腹泻、腹痛症状评分比较,差异有统计学意义(P<0.05)。患者年龄、吸烟与否、手术时间、术中出血量、宫颈癌分期、术后是否放疗和是否锻炼等与盆底功能障碍性疾病的发生有关(P<0.05),且患者年龄、手术时间、术中出血量、术后是否放疗为盆底功能障碍性疾病发生的独立影响因素。结论宫颈癌全子宫切除术后发生的盆底功能障碍性疾病严重危害患者的健康和生活质量。患者年龄、手术时间、术中出血量、是否放疗为盆底功能障碍性疾病发生的独立影响因素。     

不同时机盆底康复治疗对宫颈癌Piver Ⅲ型子宫切除术患者术后盆底功能的影响

目的:探讨不同时机盆底康复治疗对宫颈癌Piver Ⅲ型子宫切除术患者术后尿潴留、留置尿管时间、排尿功能、盆底肌电生理功能及盆底功能障碍的影响。方法:选取2019年01月至2020年06月在我院妇科行Piver Ⅲ型子宫切除术+双侧盆腔淋巴结清扫术并经术后病理结果证实的宫颈癌患者64例为研究对象。按照随机数字表法分组，最终纳入观察组与对照组，各30例。观察组术后7天开始盆底康复治疗，对照组术后14天开始盆底康复治疗，两组的盆底康复治疗方法、疗程一致。比较两组患者术后尿潴留情况及留置尿管时间；于治疗前、术后1个月、术后3个月观察比较两组患者自由尿流率、盆底肌电生理功能、盆底功能障碍评价。结果:观察组患者尿潴留发生率低于对照组(P＜0.05)；观察组患者留置尿管时间短于对照组(P＜0.05)。术后1个月、术后3个月，观察组患者最大尿流率(Qmax)、平均尿流率(Qave)及排尿量高于对照组(P＜0.05)；观察组患者排尿时间、残余尿量低于对照组(P＜0.05)；观察组患者Ⅰ、Ⅱ类肌纤维肌力、盆底动态压力、肌电位高于对照组(P＜0.05)；观察组患者POPDI-6、CRADI-8、UDI-6及PFDI-20总分低于对照组(P＜0.05)。结论:早期介入盆底康复治疗可有效降低宫颈癌行Piver Ⅲ型子宫切除术患者术后尿潴留发生率，缩短尿管留置时间，并提高盆底肌力，改善盆底功能。     

肝癌术后肝动脉化疗栓塞治疗患者肿瘤复发的影响因素分析

目的 探讨影响肝癌术后经导管肝动脉化疗栓塞治疗(TACE)患者肿瘤复发的危险因素.方法 选择并收集200例肝癌患者的年龄、性别等一般人口学特征和临床特征资料并对患者进行随访追踪,采用Logistic逐步回归分析法分析肿瘤复发的影响因素.结果 在200例患者中130例有肿瘤复发,占65.0％.Logistic逐步回归分析结果显示,血管癌栓(OR=3.796;95％CI:1.871～7.702)、侵透肝被膜(OR=3.340;95％CI:1.067～10.451)、肝硬化(OR=2.790;95％CI:1.771～4.396)、包膜完整性(OR=2.048;95％CI:1.273～3.298)和最大癌结节直径(OR=1.739;95％CI:1.014～2.980)是肝癌术后TACE治疗患者肿瘤复发的危险因素.结论 肝癌术后TACE治疗患者的肿瘤复发率较高,术前有无血管癌栓、侵透肝被膜和肝硬化,包膜是否完整,以及肿瘤的直径等均会影响肿瘤复发,临床需要加强患者术后复诊和康复治疗.     

老年髋部骨折术后对侧再骨折的独立风险因素分析

目的探讨髋部骨折术后 3 年内对侧髋部再骨折发生的独立风险因素。方法采用回顾性研究,选择 2014 年 1 月至 2017 年 12 月笔者所在单位收治的髋部骨折患者作为研究对象,根据术后 3 年内是否发生对侧髋部骨折,分为初次骨折组和再次骨折组。分别对两组患者的年龄、性别、初次骨折类型、对侧髋部骨密度、并存病、内固定方式、麻醉方式进行单因素和多因素 Logistic 分析,分析髋部骨折后再骨折的独立风险因素。结果 2014 年 1 月至 2017 年 12 月共纳入 567 例老年髋部骨折患者,术后 3 年内有 74 例 (13.1%) 患者发生对侧髋部再骨折,术后 1 年是再骨折发生高峰期。单因素分析年龄 (P=0.002),男性 (P=0.014),高血压病 (P=0.022)、痴呆 (P=0.007)、并存病数量≥ 4 项 (P=0.000) 和脆性骨折病史 (P=0.000) 差异有统计学意义,同时对侧髋部再骨折组患者的骨密度值 (P=0.012),初次髋部骨折行骨折内固定术 (P=0.033)和股骨转子间骨折 (P=0.022) 与初次骨折组比较,差异有统计学意义。多因素 Logistic 回归分析显示:高龄 (OR=1.050,95% CI=1.011～1.090,P=0.012)、高血压病 (OR=1.836,95% CI=1.029～3.277,P=0.040)、痴呆 (OR=2.244,95% CI=1.048～4.804,P=0.037)、骨密度 (OR=1.175,95% CI=1.049～1.454,P=0.039)、伤前脆性骨折史 (OR=6.614,95% CI=3.254～13.447,P=0.000) 是术后 3 年内发生对侧髋部骨折的独立风险因素。结论老年髋部骨折术后对侧髋部再骨折发生率高,术后 1 年是再骨折发生高峰期;高龄、高血压病、痴呆、骨密度、伤前脆性骨折史是术后发生对侧骨折的独立风险因素。     

腹腔镜下宫颈癌根治术的近期疗效及患者预后的影响因素分析

目的：分析腹腔镜宫颈癌根治术的近期疗效及患者预后的影响因素。方法回顾性分析128例行腹腔镜宫颈癌根治术患者的病历资料,评价手术效果,术后生存情况并分析生存影响因素。结果128例患者均成功完成腹腔镜宫颈癌根治术,淋巴结的清除量是（22.34±2.42）枚,术中出血量为（203.24±23.56）ml,需术中输血的患者为6.25%（8/128）,术后体温恢复至正常时间为（3.04±0.45）d,术后肛门排气时间为（2.13±0.24）d,术后平均住院时间为（12.23±2.42）d,术后尿管留置时间为（14.21±0.42）d。围手术期并发症的发生率为4.69%（6/128）,术后并发症的发生率为40.63%（52/128）。术后2年的病死率为6.25%（8/128）。临床分期（OR=3.164,95%CI：1.762~5.682）、肌层浸润（OR=1352,95%CI：1.063~1.720）、盆腔淋巴结（OR=2.473,95%CI：1.034~5.915）、脉管癌栓（OR=3.245,95%CI：1.267~8.311）是影响预后的独立危险因素。分化程度（OR=0.341,95%CI：0.172~0.676）是预后的保护因素。结论宫颈癌腹腔镜根治术为安全有效的手术方式,临床分期、肌层浸润、盆腔淋巴结、分化程度、脉管癌栓是腹腔镜宫颈癌根治术后患者预后的影响因素。     

老年肺癌患者术后合并下呼吸道感染的相关因素分析

目的 探讨影响老年肺癌患者术后合并下呼吸道感染的危险因素,并根据研究结果制定相应的防治措施.方法 收集2014年1月至2015年4月期间在上海交通大学附属仁济医院南院进行手术治疗的老年肺癌患者182例,根据术后是否发生下呼吸道感染分为感染组(29例)和对照组(153例).对可能影响患者术后下呼吸道感染的危险因素进行单因素和多因素Logistic回归分析.结果 单因素结果显示,老年肺癌患者术后并发下呼吸道感染与年龄(f=-3.03,P＜0.01)、吸烟(r=5.69,P=0.02)、血浆白蛋白(￡=2.40,P=0.02)、用力呼气量(FEV)1.0％(=5.85,P＜0.01)、肺癌分期(x2=7.06,P=0.01)、小细胞癌(x2 =5.09,P=0.02)、合并慢性阻塞性肺疾病(COPD)(x2=16.28,P＜0.01)、合并冠心病(x2=10.13,P＜0.01)相关.多因素Logistic回归结果显示,年龄(OR=1.34,95％ CI:1.13 ～ 1.59,x2=11.17,P＜0.01)、吸烟(OR=12.68,95％ CI:2.06 ～ 78.04,x2 =7.50,P=0.01)、FEV1.0％(OR =0.90,95％CI:0.83 ～0.97,x2 =7.76,P=0.01)、鳞状细胞癌(OR=6.88,95％ CI:1.41 ～33.56,x2 =5.70,P=0.02)、合并COPD(OR=12.44,95％CI:1.41 ～ 109.90,x2 =5.15,P=0.02)和合并冠心病(OR=10.61,95％CI:2.25 ～90.50,x2=7.18,P=0.01)是老年肺癌患者术后发生下呼吸道感染的独立危险因素.结论 高龄、有吸烟史、鳞状细胞癌、低FEV1.0％、合并COPD或冠心病的老年肺癌患者术后容易发生下呼吸道感染;应该采取综合有效的防治措施以降低老年肺癌患者术后下呼吸道感染的发生.     

腹膜后肿瘤术后尿瘘的危险因素分析

目的分析腹膜后肿瘤术后发生尿瘘的危险因素并总结尿瘘的处理经验。方法回顾性分析2009-04-2014-04首都医科大学附属北京世纪坛医院普通外科行腹膜后肿瘤手术的530例患者,术后随访2~6个月,期间发生尿瘘29例,对其危险因素进行Logistic多因素分析,进而总结预防和处理尿瘘并发症的经验。结果530例患者中有29例发生尿瘘,其中输尿管瘘25例,膀胱瘘4例,经Logistic回归分析发现,发生尿瘘并发症的相关因素中术区放疗史是最大的危险因素(OR=80.973),其次是肿瘤最大直径(OR=58.258);术前血白蛋白水平(OR=0.021)是最大的保护因素,其次是输尿管支架置入术(OR=0.054)。25例输尿管瘘患者均先行超声引导下肾盂造瘘术,充分转流尿液。有5例经肾盂造瘘引流术后自愈,2例引流随访期间肿瘤复发死亡,8例输尿管瘘再行经皮下隧道肾盂膀胱导管引流术后治愈,其余10例输尿管瘘患者接受再次开腹部手术治疗后愈合。4例膀胱瘘患者行留置尿管及膀胱冲洗治疗,其中3例自行愈合,1例再行膀胱造瘘术后自行愈合。结论腹膜后肿瘤手术患者,因术区放疗史、肿瘤较大、术前血白蛋白水平低和未放置输尿管支架者,易发生尿瘘;发生尿瘘患者经肾盂造瘘、膀胱造瘘、留置尿管以及皮下隧道肾盂膀胱导管引流术和开腹手术,均可获得治愈。     

经皮椎间孔镜治疗腰椎间盘突出症术后复发影响因素研究

目的分析经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症复发的危险因素。方法纳入自 2014 年 1 月至 2017 年 12 月,在我院接受椎间孔镜髓核摘除术治疗的腰椎间盘突出症患者 168 例,其中男99 例,女 69 例;平均年龄 (42.51±14.83) 岁。术前对患者的一般情况 (性别、年龄、身高、体重等)、糖尿病病史、高血压病史、饮酒史、吸烟史、腰椎间盘突出类型等进行采集,术后对其复发状况进行随访观察,并分别于术前、术后即刻和术后 6 个月采用疼痛视觉模拟评分 (visual analogue scale,VAS) 来评价患者的疼痛程度。采用 Cox 比例风险模型来分析术后复发的危险因素。结果本组 168 例中,术后复发 17 例,复发率 10.12%。单因素分析显示在复发组和非复发组之间,体质量指数 (body mass index,BMI) ≥ 24 (HR=5.11,95% CI:1.17~22.37),糖尿病 (HR=2.91,95% CI:1.08~7.84) 是腰椎间盘突出症术后复发 (postoperative recurrent lumbar disc herniation,PRLDH) 的危险因素,腰椎间盘脱出 (HR=0.31,95% CI:0.10~0.95) 是 PRLDH 的保护因素。多因素分析显示,吸烟 (HR=2.86,95% CI:1.03~7.99),高 BMI (HR=4.51,95% CI:1.02~19.90),糖尿病 (HR=3.06,95% CI:1.13~8.28) 是 PRLDH 的危险因素,而腰椎间盘脱出 (HR=0.32,95% CI:0.10~0.98) 是 PRLDH 保护因素。结论吸烟、高 BMI、糖尿病是 PRLDH 发生的危险因素,腰椎间盘脱出是 PRLDH 发生的保护因素。     

肺癌根治术后胸部并发症及其危险因素分析

目的:本文旨在探讨肺癌术后胸部并发症的影响因素,为临床提供更多的循证医学证据.方法:回顾性分析2014年6月至2016年3月在中国医科大学附属盛京医院胸外科行肺叶切除术、系统淋巴结清扫术,术后病理证实为Ⅰ-Ⅲ期肺癌患者的临床资料.按照是否发生胸部并发症分为两组,分析比较两组患者的特征.对两组患者的一般资料、术前合并症、术前检查、手术情况等进行单因素分析,对有显著性差异的结果纳入二元Logistic回归方程进行多因素分析.结果:对单因素分析具有统计学差异的指标进行二元Logistic回归多因素分析,结果显示患者年龄(OR=1.053,95％ CI:1.02 ～1.088,P=0.002)、手术部位(P =0.024)、手术方式(OR=2.257,95％ CI:1.287～3.957,P=0.005)及手术持续时间(OR=1.007,95％ CI:1.002～1.011,P =0.004)与无并发症组相比具有统计学差异(P＜0.05).结论:患者年龄、手术部位、手术方式及手术持续时间是肺癌术后发生胸部并发症的危险因素.     

Central venous catheter and Stenotrophomonas maltophilia bacteremia in cancer patients

BACKGROUND: Stenotrophomonas maltophilia bacteremia is frequently found in cancer patients. This study attempted to determine how often the catheters were the source of this infection and the risk factors associated with catheter-related bacteremias. METHODS: The microbiology records were retrospectively reviewed of all cancer patients having S. maltophilia bacteremia and indwelling central venous catheters seen between January 1998 and January 2004. In a multivariate analysis the patients' clinical characteristics, antimicrobial therapy, outcome, and source of bacteremia that were significantly associated with definite catheter-related S. maltophilia bacteremia as opposed to secondary bacteremia were identified. RESULTS: A total of 217 bacteremias were identified in 207 patients: 159 (73%) were primary catheter-related (53 definite, 89 probable, and 17 possible), 11 (5%) were primary noncatheter-related, and 47 (22%) were secondary. Multivariate analysis showed the following factors to be independently associated with definite catheter-related bacteremias: 1) polymicrobial bacteremia (odds ratio [OR], 7.6; 95% confidence interval [95% CI], 1.3-45.5); 2) no prior intensive care unit admission (OR, 0.06; 95% CI, 0.005-0.578); and 3) nonneutropenic status at onset (OR, 0.07; 95% CI, 0.013-0.419). The response rate to appropriate antibiotics and catheter removal was 95% in the patients with definite catheter-related bloodstream infections, compared with only 56% in the patients with secondary bacteremias (P = .001). CONCLUSIONS: The majority of the S. maltophilia bacteremias occurring in cancer patients with indwelling central venous catheters appear to be catheter-related and are often polymicrobial. Catheter-related S. maltophilia bacteremias occurred more frequently in noncritically ill, nonneutropenic patients, and prompt removal of the catheter was found to be associated with a better prognosis.     

宫颈癌放疗血液学毒性与临床因素及骨盆骨髓剂量的相关性研究

目的:探讨临床因素和放疗剂量学因素对宫颈癌放射治疗急性血液学毒性(hematological toxicity,HT)的影响,以寻求方法减少HT的发生。方法:分析2018年11月至2021年2月在我院放疗中心接受根治性放疗的67例宫颈癌患者发生急性血液学毒性的因素,临床因素包括年龄、分期、病理类型、有无同步化疗等,剂量学因素包括骨盆骨髓V5、V10、V15、V20、V25、V30、V35、V40、V45、V50、Dmax、Dmin、Dmedian、Dmean、PTV的V100(%)、Dmedian、Dmean,以及外照射剂量、SIB、外照射野数、CI、HI。结果:单因素及相关分析显示,HT 0-2级与HT 3-4级的分期、同步化疗、骨盆骨髓的V30、V35、V40、V45、V50、Dmax、Dmedian有显著差异（P＜0.05）;Logistic多因素分析显示同步化疗（P=0.002,OR=33.942）、骨盆骨髓V40＞34.116%（P=0.002,OR=11.543）是发生3-4级HT的独立危险因素;亚组分析发现同步化疗患者中,骨盆骨髓V40＞34.116%时发生3-4级HT的患者显著增多（P=0.008）。结论:同步化疗和骨盆骨髓V40＞34.116%是宫颈癌根治性放疗患者发生3-4级急性HT的原因,骨盆骨髓剂量限定有助于减少血液学毒性的发生,使患者顺利完成治疗。     

Factors Associated with Development of High-Grade Squamous Intraepithelial Lesions of the Uterine Cervix in Women Younger than 30 Years

Objective: To determine the factors associated with the increased risk of developing high-grade squamousintraepithelial lesions (HSIL) of the uterine cervix in women younger than 30 years compared with those aged ≥ 30years who also had HSIL. Methods: Patients with HSIL who underwent loop electrosurgical excision procedure (LEEP)between January 2006 and July 2017 at Chiang Mai University Hospital were retrospectively reviewed. We analyzedthe factors associated with the development of HSIL by comparing two age groups between women aged < 30 yearsand those aged ≥ 30 years. The factors analyzed included the well-recognized risk factors for cervical cancer, i.e. ageat sexual debut, number of sexual partners, use of oral contraceptive (OC) pills, smoking history, sexually transmitteddiseases and HIV status. Univariate and multivariate logistic regressions were used to assess factors associated withthe increased risk of developing HSIL in women younger than 30 years compared with those aged ≥ 30 years. Results:During the study period, there were 345 patients with HSIL, 30 were < 30 years (case group) and 315 aged ≥ 30 years(control group). By multivariate analyses , early sexual debut(OR, 2.86; 95% CI, 1.01-8.13; P=0.047), multiple sexualpartners (OR, 2.94; 95% CI, 1.23-7.02; P=0.015), history of genital warts (OR, 20.46; 95% CI, 2.27-183.72; P=0.007)and history of smoking (OR, 2.95; 95% CI, 1.10-7.93; P=0.032) were significantly associated with the developmentof HSIL in women younger than 30 years when compared with those aged ≥ 30 years. The OC use, HIV status andunderlying diseases were not significantly different in both groups. Conclusion: Early age at sexual debut, multiplesexual partners, history of genital warts and smoking are significant risk factors for developing HSIL in women youngerthan 30 years. Cervical cancer screening should be considered in young women with such factors.     

Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy

PURPOSE: To identify dosimetric parameters associated with acute hematologic toxicity (HT) and chemotherapy delivery in cervical cancer patients undergoing concurrent chemotherapy and intensity-modulated pelvic radiotherapy. METHODS AND MATERIALS: We analyzed 37 cervical cancer patients receiving concurrent cisplatin (40 mg/m(2)/wk) and intensity-modulated pelvic radiotherapy. Pelvic bone marrow (BM) was contoured for each patient and divided into three subsites: lumbosacral spine, ilium, and lower pelvis. The volume of each region receiving 10, 20, 30, and > or =40 Gy (V(10), V(20), V(30), and V(40), respectively) was calculated. HT was graded according to the Radiation Therapy Oncology Group system. Multivariate regression models were used to test associations between dosimetric parameters and HT and chemotherapy delivery. RESULTS: Increased pelvic BM V(10) (BM-V(10)) was associated with an increased Grade 2 or worse leukopenia and neutropenia (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.24-3.53; p = 0.006; and OR, 1.41; 95% CI, 1.02-1.94; p = 0.037, respectively). Patients with BM-V(10) > or =90% had higher rates of Grade 2 or worse leukopenia and neutropenia than did patients with BM-V(10) <90% (11.1% vs. 73.7%, p < 0.01; and 5.6% vs. 31.6%, p = 0.09) and were more likely to have chemotherapy held on univariate (16.7% vs. 47.4%, p = 0.08) and multivariate (OR, 32.2; 95% CI, 1.67-622; p = 0.02) analysis. No associations between HT and V(30) and V(40) were observed. Dosimetric parameters involving the lumbosacral spine and lower pelvis had stronger associations with HT than did those involving the ilium. CONCLUSION: The volume of pelvic BM receiving low-dose radiation is associated with HT and chemotherapy delivery in cervical cancer patients undergoing concurrent chemoradiotherapy.     

Risk Factor Analysis for Breast Cancer in Premenopausal and Postmenopausal Women of Punjab,India

Objective: Amritsar, the second largest town of agrarian state of Punjab, India reports high number of breast cancer cases every year. The present study investigated the etiology of breast cancer using various obesity indices and other epidemiological factors among breast cancer patients residing in and around Amritsar city. Methods: In this case control study, risk factors for breast cancer were analyzed in 542 female subjects: 271 females with breast cancer patients and 271 unrelated healthy females matched for age as control females. Results: Bivariate analysis for risk factors in cases and controls showed a lower risk (OR=0.65, 95% CI 0.43-0.99, p=0.04) in obese cases with BMI≥25kg/m2 as compared to subjects with normal BMI. Risk factor analysis showed that parameter which provided risk for cancer in postmenopausal women was obesity and in premenopausal women was parity. Postmenopausal women with BMI (overweight: OR=0.39, 95% CI 0.17-0.92, p=0.03; obese: OR= 0.26, 95% CI 0.13-0.52, p=0.00), WC (OR=0.17, 95% CI 0.05-0.52, p=0.00) and WHtR (p=0.02) had highr risk. Premenopausal women with 3 or less than 3 children had a higher risk (OR=5.54, 95 % CI 2.75-11.19, p=0.00) than postmenopausal women when compared to women with more than 3 children. Binary logistic regression analysis revealed that low parity (≤3) substantially increased the risk for breast cancer (OR=4.80, 95% CI 2.34-9.85, p=0.00) in premenopausal women. Conclusion: Obesity, parity associated breast cancer risk and reduced breastfeeding cumulatively predispose the premenopausal women of this region to higher risk of breast cancer.     

宫颈癌淋巴结转移风险的临床及预后分析

目的:探索临床病理因素及血清肿瘤标志物与总体宫颈癌盆腔淋巴结转移的关系及淋巴结转移对预后的影响。方法:收集386例Ⅰa-Ⅱb期宫颈癌住院手术患者的临床资料,血清肿瘤标志物水平,对淋巴结转移及预后的高危因素进行单因素与多因素分析。结果:总体盆腔淋巴结转移率为25.0%（89/356）;肿瘤直径≥4cm（OR=2.778,95%CI:1.410-5.131,P=0.001）,术前SSCAg水平>3ng/ml(OR=2.645,95%CI:1.106-4.673,P=0.019)是盆腔淋巴结转移的独立危险因素。病理类型（RR=3.638,95%CI:1.146-5.891,P=0.002）、FIGO分期（RR=2.672,95%CI:1.063-6.367,P=0.007）、SSCAg(RR=2.187,95%CI:1.121-4.287,P=0.001）对预后有影响。结论:肿瘤直径、术前SSCAg水平是盆腔淋巴结转移的独立危险因素,病理类型、FIGO分期及SSCAg水平是影响宫颈癌盆腔淋巴结转移患者预后的独立危险因素。     

Factors Associated with Late Diagnosis of Cervical Cancer in Nepal

Background: The majority of cervical cancers, the most prevalent cancer among Nepali women, are diagnosedin advanced stage leading to high mortality in Nepal. The present study explored factors associated with latediagnosis. Materials and Methods: A cross-sectional study was carried out in two specialized cancer hospitalsof Nepal from August 12 to October 12, 2012. Randomly selected 110 cervical cancer patients were interviewedand their medical records were reviewed. Multivariate logistic regression analysis was performed to predictassociations. Results: Mean age of patients was 52.7years (SD=10.6), 66% were illiterate and 77% were ruralinhabitants. Medical shops (33.6%) and private hospitals (31%) were major first contact points of patientswith health care providers (HCP). There was no cervical/per-speculum examination (78.2%) and symptomsmisinterpretation (90%) of patients occurred in initial consultation with HCP. Four in every five cases (80.9%)of cervical cancer had late diagnosis. Literate women (adjusted OR=0.121, CI: 0.030-0.482) and women havingabnormal vaginal bleeding as early symptom (adjusted OR=0.160, CI: 0.035-0.741) were less likely to suffer latediagnosis. Women who shared their symptoms late (adjusted OR=4.272, CI: 1.110-16.440) and did so with peopleother than their husband (adjusted OR=12.701, CI: 1.132-142.55) were more likely for late diagnosis. Conclusions:High level of illiteracy among women and their problematic health seeking behavior for gynecological symptomsare responsible for late diagnosis of cervical cancer in Nepal. In the absence of a routine screening program,prevention interventions should be focused on raising awareness of gynecological symptoms and improvinghealth seeking behavior of women for such symptoms.