CO2激光治疗宫颈尖锐湿疣104例疗效观察

目的和方法为了治疗宫颈尖锐湿疣，采取CO2激光治疗方法。结果宫颈尖锐湿疣一次性近期治愈率为95％，复发率为5％；妊娠期宫颈尖锐湿疣一次性近期治愈率为90％，复发率为10％。结论CO2激光治疗宫颈尖锐湿疣，具有投资少、操作方便、一次性近期治愈率高、复发率低、治疗效果显著、治疗费用低、一般不需药物治疗、不需住院治疗、非接触性治疗的优势，可作为基层医院、社区医疗机构治疗宫颈尖锐湿疣、早期防治宫颈癌的首选方法进行普及应用。     

宫颈HPV感染、CIN及宫颈癌3年发生情况分析

目的:分析该院近3年4 577例阴道镜下活检病例,了解该地区宫颈HPV感染、CIN及宫颈癌发生率逐年变化情况。方法:对2006~2008年有临床指征的患者,在阴道镜下多点活检。结果:2006年、2007年、2008年病毒感染率分别为5.20%、8.94%、9.12%,CIN发病率分别为3.03%、4.73%、5.65%,宫颈癌发病率分别为1.59%、3.76%、4.19%。结论:该地区宫颈HPV感染、CIN及宫颈癌的发病率明显上升并有年轻化趋势。     

宫颈糜烂与宫颈CIN及宫颈癌相关性的临床分析

目的对宫颈糜烂和宫颈CIN以及宫颈癌之间的相关关系进行探讨。方法随机选取在我院治疗宫颈病变的患者共120例,将其按照宫颈的糜烂程度分为四组,然后比较四组在CIN疾病和宫颈癌疾病上的构成。结果存在糜烂的三组的CIN和宫颈癌疾病构成上不存在显著差异,而不存在糜烂的那组与其他三组间在疾病构成上存在显著,差异具有统计学意义,P〈0.05。结论宫颈糜烂与发生CIN和宫颈癌之间不存在明显的相关性,因此宫颈糜烂不是宫颈病变高危因素的一种。     

宫颈糜烂与宫颈CIN及宫颈癌相关性的临床分析

目的:探讨宫颈糜烂与宫颈CIN及宫颈癌的关系。方法:对2008～2009年在山西省人民医院门诊就医的宫颈糜烂患者临床资料进行分析。结果:宫颈CIN及宫颈癌趋于年轻化,宫颈糜烂与宫颈CIN及宫颈癌之间无明显相关性。结论:宫颈糜烂是宫颈CIN及宫颈癌的前期表现,但宫颈靡烂面积、深度与宫颈CIN及宫颈癌不成正比。     

阴道镜诊断74例宫颈尖锐湿疣的临床分析

目的:探讨阴道镜诊断宫颈尖锐湿疣的价值。方法:将2003年10月6日～2005年6月30日阴道镜诊断的74例宫颈尖锐湿疣(CA)与其病理检查结果进行对比分析。结果:阴道镜诊断宫颈CA与病理诊断符合率达85.10%。结论:阴道镜检查宫颈CA简便、有效,值得推广应用。     

170例宫颈癌术前宫颈细胞学与组织学诊断分析

宫颈癌是女性常见的恶性肿瘤之一 ,其发病率居妇科恶性肿瘤之首 ,严重危害妇女健康。早期诊断是提高宫颈癌治愈率及降低宫颈癌死亡率的关键。本文通过对宫颈癌患者术前宫颈细胞学与组织学诊断的对比研究 ,探讨提高宫颈癌细胞学诊断的正确性 ,提高宫颈癌的早期诊断率。对象与方法1　对象　 1996 1～ 2 0 0 1 12在我院住院的 170例宫颈癌患者。年龄 5 1± 10 5 2岁 (2 6～ 82岁 ) ,结婚年龄最大 2 7岁 ,最小 17岁 ,平均 2 2± 2 72岁。孕次最多 9次 ,最少 1次 ,平均 4次。产次最多 8次 ,最少 0次 ,平均 2次。入院主诉不规则阴道出血 97例、…     

宫颈癌前病变和宫颈癌筛查新进展

目的:探讨宫颈癌前病变和宫颈癌筛查国内外研究最新进展,为临床诊治提供帮助。方法:查阅近年来国内外有关宫颈癌前病变和宫颈癌筛查国内外相关研究,总结筛查方式进展,寻找存在问题。结果:HPV DNA检测在宫颈癌前病变及宫颈癌筛查中作用关键,但与细胞学、阴道镜及病理组织学检查联合诊断方式仍然有待优化。结论:HPV DNA检测可有效提示宫颈病变预后,但其早期预测特异性较低,具有早期预测宫颈癌发生风险的实验室指标还需寻找。     

宫颈癌前病变及宫颈癌的早期社区干预

[目的]探讨社区早期干预对宫颈癌前病变及宫颈癌的预防及治疗效果及早期社区干预对降低宫颈癌前病变及宫颈癌发生的实践可行性。[方法]对2004年4月～2008年11月本院182例宫颈病变病人进行早期社区干预。[结果]宫颈癌前病变的发生率为4.42%,社区干预4年后宫颈癌前病变的发生率为2.43%。观察组社区干预后宫颈癌前病变的发生率明显低于对照组。19～35岁年龄组的宫颈癌前病变的发生率为2.6%,35～50岁年龄组宫颈癌前病变的发生率为2.7%,50岁以上年龄组宫颈癌前病变的发生率为0.5%。[结论]宫颈癌前病变及宫颈癌的早期社区干预在早期发现宫颈癌前病变,给与干预治疗,避免或延缓宫颈癌前病变的发生、发展,防止宫颈癌的发生具有重要意义。     

宫颈刮片、阴道镜、宫颈活检在女性宫颈癌筛查中的应用体会

目的：探讨宫颈刮片、阴道镜及宫颈活检在宫颈癌筛查中的应用。方法：以宫颈活检为金标准,比较宫颈刮片、阴道镜检查两种方法的敏感率、特异性。结果：520例宫颈病检阳性患者中,宫颈刮片敏感率62％,阴道镜敏感率77％,宫颈刮片特异性71％,阴道镜特异性43％,二者比较差异有统计学意义（P〈0．05）。结论：对于宫颈癌的筛查及早期诊断,应三种方法结合,以提高检出率。     

宫颈刮片在边远地区筛查和预防宫颈癌的应用

目的:探讨宫颈刮片对固定已婚妇女(边远地区)子宫癌的预防和筛查。方法:采用TBS分级系统进行细胞学诊断,通过对边远地区已婚妇女,2003年至2009年宫颈刮片的结果进行分组和统计学分析。结果:分级在高度鳞状上皮内病变(HSIL)以上35～50岁人群所占比例较大,而且有向年轻化趋势发展;分级在HSIL以上人群所占比例具有逐年下降的趋势,具有统计学的意义。结论:宫颈刮片对固定人群预防和筛查宫颈癌具有较大的社会效益和经济效益,但在诊断和确诊宫颈癌方面还需要进一步做薄层液基细胞学试验(TCT)和阴道镜活体检查。     

宫颈HPV亚临床感染与外阴湿疣和宫颈糜烂的相关性

目的:探讨外阴湿疣及宫颈炎症与宫颈HPV亚临床感染(SPI)的关系以及SPI与高危型HPV DNA感染的相关性。方法:对169例研究对象进行基本情况问卷调查,通过宫颈液基细胞检查、阴道镜检查及阴道镜下取组织进行病理诊断,或术后宫颈病理检查,判定有无SPI感染。通过杂交捕获试验Ⅱ检测高危型HPV DNA感染。结果:宫颈SPI的检出率为外阴湿疣组53.1%,宫颈糜烂组为22.7%(P<0.05);97例宫颈糜烂患者中,Ⅰ、Ⅱ、Ⅲ度患者的PSI感染率有逐渐上升趋势,但三者差异无显著性(P>0.05);单纯型、颗粒型、乳头型宫颈糜烂组SPI感染率分别为20.0%、23.4%、22.5%,颗粒型和乳头型糜烂中的SPI感染率略高于单纯型,但三者差异无显著性(P>0.05)。高危HPV DNA的检出率为外阴湿疣组41.7%、宫颈糜烂组为28.7%、正常对照组为8.3%。与正常对照组比较,实验组高危HPV DNA检出率明显提高(P<0.01);宫颈糜烂组与外阴湿疣组比较,高危HPV DNA检出率无统计学意义(P>0.05)。高危型HPV DNA检出率在SPI阳性病例与阴性病例中的检出率分别为69.2%和7.8%,SPI阳性病例与阴性病例比较,高危型HPV DNA检出率明显提高(P<0.01)。结论:外阴湿疣、宫颈炎症患者是宫颈SPI的高危人群,且SPI病例中高危HPV DNA的检出率高于非SPI病例,应重点随访和管理。     

Colorectal cancer screening practices among cancer survivors five years after diagnosis

Background

Colorectal cancer (CRC) has a high incidence worldwide, especially in high-income countries. In France, a national CRC screening program targeting residents aged 50–74 years has been in place since 2009. Little is known about CRC screening practices in cancer survivors, even though some have an increased risk of developing a second cancer in the colorectum. This study aims to identify the barriers to CRC screening among cancer survivors.

Methods

This cross-sectional study based on the French national VICAN survey included individuals diagnosed in 2010 with a cancer in 1 of 11 locations other than the colorectum and interviewed 5 years after diagnosis about various health-related issues. Binary logistic regression was used to identify the factors associated with lack of up-to-date CRC screening in cancer survivors without cancer progression.

Results

Of the 2935 cancer survivors included in the study, 35.3% reported undergoing a screening test in the previous 2 years. The rate of up-to-date CRC screening rose to 49.3% in survivors aged 51–75 years. Among these, lack of CRC screening in the recommended time frame was associated with obesity, current smoking, non-use of complementary medicine, perceived financial difficulties, and poor access to general practitioners.

Conclusions

Barriers to CRC screening can be personal and/or institutional.

     

Cost-effectiveness of increasing cervical cancer screening coverage in the Middle East: An example from Lebanon

BackgroundMost cervical cancer (CC) cases in Lebanon are detected at later stages and associated with high mortality. There is no national organized CC screening program so screening is opportunistic and limited to women who can pay out-of-pocket. Therefore, a small percentage of women receive repeated screenings while most are under-or never screened. We evaluated the cost-effectiveness of increasing screening coverage and extending intervals.MethodsWe used an individual-based Monte Carlo model simulating HPV and CC natural history and screening. We calibrated the model to epidemiological data from Lebanon, including CC incidence and HPV type distribution. We evaluated cytology and HPV DNA screening for women aged 25–65 years, varying coverage from 20 to 70% and frequency from 1 to 5 years.ResultsAt 20% coverage, annual cytologic screening reduced lifetime CC risk by 14% and had an incremental cost-effectiveness ratio of I$80,670/year of life saved (YLS), far exceeding Lebanon’s gross domestic product (GDP) per capita (I$17,460), a commonly cited cost-effectiveness threshold. By comparison, increasing cytologic screening coverage to 50% and extending screening intervals to 3 and 5 years provided greater CC reduction (26.1% and 21.4, respectively) at lower costs compared to 20% coverage with annual screening. Screening every 5 years with HPV DNA testing at 50% coverage provided greater CC reductions than cytology at the same frequency (23.4%) and was cost-effective assuming a cost of I$18 per HPV test administered (I$12,210/YLS); HPV DNA testing every 4 years at 50% coverage was also cost-effective at the same cost per test (I$16,340). Increasing coverage of annual cytology was not found to be cost-effective.ConclusionCurrent practice of repeated cytology in a small percentage of women is inefficient. Increasing coverage to 50% with extended screening intervals provides greater health benefits at a reasonable cost and can more equitably distribute health gains. Novel HPV DNA strategies offer greater CC reductions and may be more cost-effective than cytology.     

Estimating the cost of cervical cancer screening in five developing countries

Background

Cost-effectiveness analyses (CEAs) can provide useful information to policymakers concerned with the broad allocation of resources as well as to local decision makers choosing between different options for reducing the burden from a single disease. For the latter, it is important to use country-specific data when possible and to represent cost differences between countries that might make one strategy more or less attractive than another strategy locally. As part of a CEA of cervical cancer screening in five developing countries, we supplemented limited primary cost data by developing other estimation techniques for direct medical and non-medical costs associated with alternative screening approaches using one of three initial screening tests: simple visual screening, HPV DNA testing, and cervical cytology. Here, we report estimation methods and results for three cost areas in which data were lacking.

Methods

To supplement direct medical costs, including staff, supplies, and equipment depreciation using country-specific data, we used alternative techniques to quantify cervical cytology and HPV DNA laboratory sample processing costs. We used a detailed quantity and price approach whose face validity was compared to an adaptation of a US laboratory estimation methodology. This methodology was also used to project annual sample processing capacities for each laboratory type. The cost of sample transport from the clinic to the laboratory was estimated using spatial models. A plausible range of the cost of patient time spent seeking and receiving screening was estimated using only formal sector employment and wages as well as using both formal and informal sector participation and country-specific minimum wages. Data sources included primary data from country-specific studies, international databases, international prices, and expert opinion. Costs were standardized to year 2000 international dollars using inflation adjustment and purchasing power parity.

Results

Cervical cytology laboratory processing costs were I$1.57–3.37 using the quantity and price method compared to I$1.58–3.02 from the face validation method. HPV DNA processing costs were I$6.07–6.59. Rural laboratory transport costs for cytology were I$0.12–0.64 and I$0.14–0.74 for HPV DNA laboratories. Under assumptions of lower resource efficiency, these estimates increased to I$0.42–0.83 and I$0.54–1.06. Estimates of the value of an hour of patient time using only formal sector participation were I$0.07–4.16, increasing to I$0.30–4.80 when informal and unpaid labor was also included. The value of patient time for traveling, waiting, and attending a screening visit was I$0.68–17.74. With the total cost of screening for cytology and HPV DNA testing ranging from I$4.85–40.54 and I$11.30–48.77 respectively, the cost of the laboratory transport, processing, and patient time accounted for 26–66% and 33–65% of the total costs. From a payer perspective, laboratory transport and processing accounted for 18–48% and 25–60% of total direct medical costs of I$4.11–19.96 and I$10.57–28.18 respectively.

Conclusion

Cost estimates of laboratory processing, sample transport, and patient time account for a significant proportion of total cervical cancer screening costs in five developing countries and provide important inputs for CEAs of alternative screening modalities.     

宫颈癌流行病学研究与调查

宫颈癌在全球妇女恶性肿瘤中居第二位,近20年发病明显呈年轻化趋势,如能早期发现是可以治愈的恶性肿瘤。该文就近年来有关宫颈癌的流行病学特点及危险因素作一综述。     

2008-2013年国内5所重点肿瘤医院SCI论文收录情况计量分析

目的 采用文献计量学的方法对国内5所重点肿瘤医院近5年SCI论文收录情况进行统计分析,为科研决策提供参考依据.方法 本文基于Web of Science SCI-E统计了国内5所肿瘤医院发表SCI科研论文的收录情况,利用citespace、pubmedplus等分析软件,基于文献计量学的研究方法,针对论文数量、学科分布、期刊和高影响因子、高频关键词、研究热点,国际合作等方面进行了多角度的对比分析.结果 反映了我国5所重点肿瘤医院SCI发表论文的现状、学科发展和整体科研能力等,进一步提升国内肿瘤医院整体科研水平.结论 评价全国肿瘤学重点学科发展地位,为科研管理部门制定学科发展规划提供决策参考依据.     

An example of record linkage methods to monitor mortality and cancer incidence

Linkage of New York State record systems was the key strategy in a restrospective cohort study with a 24–34 year followup interval. Parents of children with anencephaly or spina bifida and matched control parents were traced to determine the parents'' cancer and death experience. Birth certificates for Upstate New York for 1945–55 were the source of the study groups. This report describes the methodology employed. The New York State Health Department''s Cancer Registry and vital records, the State motor vehicle license files, and city and phone directories were searched for the most recent record indicating residence in Upstate New York, cancer incidence, or death.Among the parents of the 1,152 index children were 18,571 person-years of followup for mothers and 21,675 person-years for fathers. Among the 1,152 controls, there were 19,682 person-years of followup for mothers and 22,596 person-years for fathers. Although losses were larger than the optimal, a large proportion of the maximum possible person-years were obtained, regardless of the birth year of the index child. Patterns of loss to followup were similar for cases and controls.Record linkage techniques are especially applicable in followup studies if the risk factor is identifiiable from routinely collected information (for example, congenital neural tube defects listed on birth certificates) and the outcome is also identifiable from such records (for example, cancer registry certificate or death certificate). If the outcome is definitive, reported routinely and comprehensively, and stored on a machine-readable medium, use of a computerized record linkage design is very efficient. A major advantage of the design is that cases and controls are treated equally with respect to outcome ascertainment and followup, so that some potential biases are eliminated. Finally, the method is non-intrusive; the subjects are never contacted or interviewed. Strictly maintained confidentiality is, of course, required.