宫颈癌的预防及普查

宫颈癌是危害广大妇女健康的主要恶性肿瘤之一,是癌症造成妇女死亡的第二大因素。据WHO报道：世界每年新发现宫颈癌病例约有50万,其中我国每年新发病例有13．5万,占三分之一。由于我国积极地进行宫颈癌的预防及普查工作,其死亡率由70年代5．29／10万降至90年代1．64／10万,下降幅度为69％。上海是我国宫颈癌普查普治工作组织完善城市,宫颈癌的标化率从1978年～1982年的11．8／10万降至1995年的2．1／10万,从妇科三癌发病率最高降至最低,而且宫颈癌的患病率已低于1996年WHO报道的全世界患病率最低的以色列。     

宫颈癌更应综合防控

从20世纪50年代开始,著名妇产科专家林巧稚即倡导宫颈癌细胞筛查,随后国家开展了妇女常见病的普查普治.至20世纪80年代中期,很多癌症高发区均开展了官颈癌筛查工作.政府也拨出经费,支持妇产科医生到农村筛查.经过长期宣传教育、早期筛查,以及生育行为改变等综合措施,宫颈癌的发病率和死亡率在建国后明显下降.     

宫颈癌治疗进展

在全世界范围内,宫颈癌是发病率和死亡率仅次于乳腺癌的最常见女性恶性肿瘤,超过80％的新诊断病例发生在经济不发达国家。开展普查普治和规范治疗是降低宫颈癌死亡率的两个重要环节。     

我国妇科肿瘤研究现状与发展

在我国,妇科肿瘤作为一个亚专业已有40余年历史,经历了建立和发展阶段,目前正在走向世界,进入现代化的新纪元。40年来,子宫颈癌的发病和死亡率在广泛开展普查普治后已大幅度下降,但仍为妇科恶性肿瘤第一位。子宫内膜癌有上升和年轻化趋势,占第二位。卵巢恶性肿瘤占第三位。 一、子宫颈癌 据WHO报道,全世界宫颈癌年新发病例46万,我国13万。但我国宫颈癌发病在高、低发区显著不同,如襄垣县高发区患病率为1398/10万,而低发区上海为50/10万,一般在70～160/10万。我国于80年代初提出宫颈癌优化普查程     

南充地区10022例妇女子宫颈癌普查普治的报告

本文总结南充地区10022例妇女子宫颈癌普查普治及随访情况。查出宫颈癌12例(患病率为119.13/10万),其中临床早期癌10例(83.3%)。五年后随访结果:普查发现并经治疗的9例原位癌全部存活,其中7例来院复查,无1例复发。     

宫颈癌的流行情况调查与诊疗

目的用宫颈刮片方法对辖区8361人次宫颈癌普查普治,探讨宫颈癌流行及诊疗情况。方法对8361例妇科普查的妇女进行宫颈筛查。检查方法为宫颈刮片及阴道镜检查。对可疑者进行阴道镜下定位取活检及组织学病理检查。结果应查人数9528例,实查8361例,普查率87.75%;慢性宫颈炎5850例,发病率69.97%;宫颈癌18例,患病率215.29/10万;手术治疗14例,放化疗2例,普治率88.89%;3例原位癌术后均体健,手术治疗有效率100%;11例浸润癌Ⅰb-Ⅳb期手术及放、化疗,3年存活率27.27%;放、化疗后均出现程度不同的毒副作用,发生率100%;3例术后2年内出现并发症死亡,4例因期别晚,已失去手术时机,均在1年半内死亡,死亡率7.99/10万。结论慢性宫颈炎发病属首位;符合宫颈癌的发病年龄规律;宫颈刮片健康普查简便经济、可靠,适合农村妇女病普查;宫颈早期病变的治疗效果明显优于晚期;早期宫颈癌的治疗以手术治疗为主,辅以同步放疗、化疗,可以明显提高疗效。     

液基细胞学 阴道镜对宫颈病变早期诊断的价值

宫颈癌是发病率和死亡率仅次于乳腺癌的最常见的女性恶性肿瘤,80%以上的新发病例发生于发展中国家,其中我国约占1/3.宫颈癌是目前惟一病因明确,可以早发现、早诊断、早治疗的癌症,开展普查普治是降低宫颈癌死亡率的重要环节。     

1078 848例妇女普查情况分析及干预措施讨论

目的了解南京地区妇女病普查普治情况，以便有针对性地探讨干预措施。方法采用常规妇女病普查方法．并对资料进行回顾性分析。结果近五年南京城市普查率在85％以上，而农村普查率出现下降趋势；患病率城市明显高于农村，且城乡之间差异有统计学意义（P〈0．01）。每年妇科疾病中宫颈糜烂占居首位，宫颈癌、卵巢癌、性病的患病率均呈上升趋势，而乳腺癌呈下降趋势。结论妇女病普查普治工作应明确规定承担妇女病普查职责的职能机构，规范普查项目及内容，规范妇科疾病的诊治，切实提高妇女病普查普治质量。     

子宫内膜癌的治疗(综述)

子宫体癌以子宫内膜腺癌为最多见,约占90％。过去认为它的发病率仅次于子宫颈癌,在妇女生殖器官恶性肿瘤中占第二位。近年来由于开展宫颈癌普查普治,宫颈癌发病率有所下降,或宫体癌的发病有所上升,许多报导(特别在美国)宫体癌的发病率跃居妇科恶性肿瘤的首位。虽然子宫内膜腺癌是妇科恶性肿瘤中予后较好的一种,但恰当的治疗无疑能明显提高其存活率。一、子宫内膜腺癌的临床分期及组织分级     

庙城镇农村适龄妇女宫颈癌、乳腺癌筛查结果分析

目的：通过对农村妇女宫颈癌乳腺癌筛查结果的分析,了解农村妇女生殖健康状况及相关因素,探讨提高妇科疾病的普查率、两癌检出率,提高妇女生殖健康状况的有效方法。方法：采取整群抽样方法,对庙城镇25～65岁妇女采用妇科常规检查和宫颈脱落细胞巴氏涂片进行宫颈癌筛查,对40～60岁妇女采用乳腺彩色多普勒超声检查进行乳腺癌筛查;可疑病例转至怀柔区妇幼保健院进一步复诊。结果：25～65岁妇女筛查4 453名,筛查率为75.18%,检出宫颈上皮内瘤变5例,患病率为112.28/10万;40～60岁妇女筛查2 976名,筛查率为85.00%,检出乳腺癌4例,发病率为134.41/10万。结论：每年进行一次宫颈癌、乳腺癌筛查是妇科疾病普查普治工作的重要内容;强化政府责任,加大资金投入,统一筛查方法,提高筛查率及筛查质量,对早期发现宫颈癌、乳腺癌,降低两癌的患病率、病死率,提高妇女生活质量具有重要意义。     

Epidemiology of primary and secondary syphilis in the United States, 1981 through 1989

Between 1981 and 1989, the incidence of primary and secondary syphilis in the United States increased 34%, from 13.7 to 18.4 cases per 100,000 persons, the highest since 1949. The populations affected most by syphilis also changed substantially. From a peak of 10.0 cases per 100,000 persons in 1982, the incidence among white men had decreased 69% by 1989 (3.2 cases per 100,000 persons). From 1982 to 1985, the incidence also decreased among black men (30%, 101.9 to 71.5 cases per 100,000) and black women (22%, 45.8 to 35.8 cases per 100,000). However, in 1986 this trend reversed, and the incidence among blacks more than doubled from 1985 to 1989 (52.6 to 121.8 cases per 100,000 persons). Racial differences in syphilis incidence increased (black-to-white incidence rate ratio in 1981 was 14.5 and in 1989 was 47.8), as did regional differences. Trends in syphilis incidence indicate changes in sexual behavior that may determine future sexual transmission of human immunodeficiency virus. Targeting resources at populations most affected by this recent epidemic is an urgent public health priority.     

银川市老城区癫痫流行病学调查及病因学浅析

本文报告银川市老城区癫痫流行病学调查的结果。调查方法系利用世界卫生组织提供的统一的调查表,采用分层整群随机抽样法,在136,385人口之限定的样本人群中进行逐户家访调查。共调查10,641例,发现癫痫患者44例。患病率(每10万人口/年)及世界调整率、发病率(每10万人口/年)及世界调整率、死亡率(每10万人口/年)及世界调整率分别为413.5及390.4、18.8及35.2、9.4及7.3,与世界调整率相比,患病率大致相符,发病率偏低,而死亡率偏高。本文还就本症进行了病例配对对照分析,显示发热的惊厥是本症的一个危险因素。     

The incidence of non-melanocytic skin cancers in an Australian population: results of a five-year prospective study

Two thousand, six hundred and sixty-nine persons who were aged 40 years and older attended for examination of the light-exposed areas of the head and neck, forearms and dorsa of the hands during a skin-cancer survey of the population of Maryborough, which was conducted annually for five years from 1982-1986 inclusive. Sixty (2.25%) persons--12 persons each with a squamous-cell carcinoma and 48 persons with a total of 51 basal-cell carcinomas--had at least one non-melanocytic skin cancer at the first examination. One thousand, nine hundred and eighty-one (74% of the study population) persons were seen on more than one occasion, which allowed for 6288 person-years of follow-up for the determination of the incidence of new cancers. The findings showed a calculated minimal age-standardized incidence rate of 873 non-melanocytic skin cancers/100,000 population each year. The minimal incidence rate for basal-cell carcinomas was 672 cases/100,000 population each year and for squamous-cell carcinomas was 201 cases/100,000 population each year. The rate ratio of the incidence of basal-cell carcinomas to that of squamous-cell carcinomas was 3.34 to one. Age, sex, skin reaction to sunlight and occupation all were significant factors in the determination of the risk of developing non-melanocytic skin cancers. The enormous costs that are involved in the treatment of non-melanocytic skin cancers and related lesions suggest that more time, effort and money need to be spent to reduce what has become a major public-health problem in Australia.     

A 5 years prospective study of incidence, morbidity and mortality profile of stroke in a rural community of eastern India

Community-based longitudinal study on stroke is rare in India. It has been predicted that the stroke incidence will be higher in developing countries than developed countries. Hence a five years prospective study was planned to carry out in the rural Bengal, India based on WHO protocol to determine the incidence rate, risk factors, morbidity and mortality profile of stroke. In a two-stage procedure, 20717 subjects out of 20842 people from a cluster of 12 villages was surveyed by house-to-house method and the screened cases were examined by a team of neurologists including post stroke surveillance for one year. Altogether 128 first ever stroke cases were detected over 5 years showing an average annual incidence rate of 123.57 per 100,000 persons [age adjusted incidence rate (AAIR)--262/100,000; based on USA population, 1990] and sex-specific AAIR (274/100,000) among women is slightly higher than men (253/100,000). Age-specific stroke incidence rate showed increasing rate from fourth decade up to seventh decade in both sexes when the rate was maximum. First 30 days mortality recorded was 18% with men suffering twice than women. Follow-up after one year revealed speech improvement in 47%, residual spasticity in 46% and independency in activities daily living in 62% of cases. Age and sex matched case control study has shown that hypertension (OR - 2.79), heart disease (OR - 6.20) and smoking (OR - 3.92) are significant risk factors.This study had indicated a higher age adjusted incidence rate of stroke in India as compared to that of developed country and hypertension, heart disease and smoking are important risk factors.     

Deaths as a result of work-related injury in Australia, 1982-1984

A comprehensive study of deaths of work-related injuries which occurred throughout Australia in the years 1982-1984 was undertaken by means of coroners' records. Of 16,246 coroner-certified deaths that were attributed to trauma or to acute poisoning (excluding deaths of suicide or medical misadventure), the coroners' files were located for 15,462 (95.2%) deaths. From the files, a total of 1738 fatalities was judged to be work-related during the three-year period; of these, 1544 fatalities occurred in persons who were employed in the civilian labour force, which gave an average annual fatality incidence of 8.06 fatalities per 100,000 persons in the labour force. The death rate was much higher in men (12.05 fatalities per 100,000 men) than it was in women (1.34 fatalities per 100,000 women), increased with age, and was highest for the traditionally-dangerous occupations (such as mining, transport and rural occupations). The distribution of work fatalities by the main cause of death, and the nature of the injury event is described.     

Epidemiology of cancer of the cervix: global and national perspective

Cancer of the uterine cervix is one of the leading causes of cancer death among women worldwide. The estimated new cancer cervix cases per year is 500,000 of which 79% occur in the developing countries. Cancer cervix occupies either the top rank or second among cancers in women in the developing countries, whereas in the affluent countries cancer cervix does not even find a place in the top 5 leading cancers in women. The truncated rate (TR) in the age group 35-64 years in Chennai, India, is even higher (99.1/100,000; 1982-95) than rate reported from Cali, Colombia (77.4/100,000, 1987-91). The cervical cancer burden in India alone is estimated as 100,000 in 2001 AD. The differential pattern of cervical cancer and the wide variation in incidence are possibly related to environmental differences. Aetiologic association and possible risk factors for cervical carcinoma have been extensively studied. The factors are: Sexual and reproductive factors, socio-economic factors (education and income), viruses e.g., herpes simplex virus (HSV), human papillomavirus (HPV), human immunodeficiency virus (HIV) in cervical carcinogenesis and other factors like smoking, diet, oral contraceptives, hormones, etc. The accumulated evidence suggests that cervical cancer is preventable and is highly suitable for primary prevention. Sexual hygiene, use of barrier contraceptives and ritual circumcision can undoubtedly reduce cervical cancer incidence. Education, cervical cancer screening of high risk groups and improvement in socio-economic status can reduce cervical cancer morbidity and mortality significantly.     

我国太行山高发区食管癌流行趋势及防治策略

目的：对我国太行山区食管癌发病率及死亡率进行趋势分析及预测,并探索加速降低食管发病率和死亡率的策略,方法：采用磁到,林县1988－1997年食管部发病,死亡资料,并运用有反馈的人工神经网络模型预测其发病率,死亡率趋势;以林县临淇镇为例,测算以内间技术为主的早诊早治对于食管癌发病,死亡的降低程度及其把握度。结果：近10年来太行山区食管癌的发病率和死亡率均呈下降趋势,但较为缓慢,预测2002年食管癌发病率男性为115．70／10万,女性为79．88／10万,食管癌死亡率男性为94．00／10万,女性为56．29／10万,食管部发病率,死亡率均仍 较高水平,如推行以内窥镜为主的早诊早治技术8年中,干预组的发病率对照组的1／3,把握度可达到88．3％,死亡率在第5年时为对照组的1／4,把握度可达到89．4％,结论：太行山区食管癌发病率,死亡率均仍属较高水平,提示应该继续深入地在该地区开展食管癌的综合防治工作,推行以内窥镜技术为主的早期诊断,早期治疗,从而可在5－8年内明显地降低食管癌死亡率和发生率,建议在该地区进行较大规模的食管癌二级预防。     

湖北省2003-2015年艾滋病抗病毒治疗死亡病例流行病学分析

目的 分析湖北省艾滋病抗病毒治疗死亡病例的流行病学特征,为降低病人死亡率,提高抗病毒治疗效果提供依据.方法 通过“国家艾滋病综合防治信息系统”,筛选1416例年龄≥15岁的艾滋病抗病毒治疗死亡患者信息,采用SPSS21.0进行统计分析.结果 死亡的1 416例艾滋病患者中,男性占68.67％,女性占31.33％,年龄最小的16岁,最大的87岁,平均死亡年龄(47.68± 12.67)岁,感染途径以性传播为主,占62.01％,婚姻状况以已婚或同居为主,占60.31％,文化程度以初中及以下水平为主,占88.7％;死亡病例在接受抗病毒治疗的3个月内病死率最高,为37.22％.所有死亡病例中,64.76％死于艾滋病相关疾病,Kaplan-Meier法生存分析显示,抗病毒治疗开始的第1年患者生存率下降最快,Log-Rank检验(P＜ 0.000 1)发现基线CD4计数≤50个/μL的生存率低于基线CD4计数为51～200个/μL组和≥201个/μL组.结论 湖北省艾滋病抗病毒治疗死亡病例病死率较高,应加强患者的早发现和早治疗,降低病死率.     

Stroke in urban and rural areas of China.

A large-scale population survey was conducted to clarify the degree of harm and feature of distribution of stroke in China. 5 800,000 of a billion people were investigated in 29 provinces and cities excluding Taiwan province. The incidence, prevalence and mortality were standardized by direct method using the world standard population. The incidence of stroke was 109.95 per 100,000 people in 1986 and its 95% CI (confidence interval) 107.25-112.65 per 100,000. The age-standardized incidence was 115.87/100,000. The point prevalence of stroke was 245.49 per 100,000 people on December 31, 1986 and its 95% CI 241.57-249.61 per 100,000, with an age-standardized prevalence of 259.86 per 100,000. The mortality of stroke was 76.78 per 100,000 in 1986 and its 95% CI 74.52-79.04 per 100,000, with an age-standardized mortality of 80.94 per 100,000. There was a tendency for the rates to increase gradually from south to north and to decrease progressively from east to west. The models of linear regression were established between latitude and rates as well as between longitude and rates. The incidence, prevalence and mortality of stroke differed significantly in various topographic areas. They were much higher in cities than in rural areas, and much higher in men than in women. The incidence, prevalence and mortality increased with age, and their relationships fitted in Logistic curve well.