5个发展中国家宫颈癌筛查的成本效益研究

背景：包括多次常规细胞学检查的宫颈癌筛查方案在发展中国家一直得不到有力推行。方法：本研究应用计算机模型评价不同宫颈癌筛查方案在印度、肯尼亚、秘鲁、南非及泰国的成本效益。原始数据包括文献中对年龄特异性癌症发病率与死亡率比的估计，以及对癌前病变的筛查和治疗的有效性。本研究根据不同的筛查测试、目标人群（以年龄划分）、筛查频率和要求就诊的次数等对相关的医疗成本、时间消耗和该项目有关成本进行了评价。单次就诊方案是指假定筛查和治疗可以在同一天完成。     

Routine prenatal ultrasound anomaly screening program in a Nigerian university hospital: Redefining obstetrics practice in a developing African country

Background:

Congenital anomalies are among the leading causes of fetal and infant morbidity and mortality worldwide. Prenatal ultrasound (US) screening has become an essential part of antenatal care in the developed world. Such practice is just evolving in the developing countries such as Nigeria. The aim of this article is to present our initial experience and demonstrate the effectiveness of a prenatal US screening program in detecting congenital malformation in a developing country.

Materials and Methods:

This was a prospective evaluation of the prenatal US screenings conducted at a major referral hospital in Southwestern Nigeria. All pregnant women referred to the antenatal clinic for mid-trimester screening during the period of study were assessed.

Results:

Two hundred and eighty-seven pregnant women (5 with twin gestations) were presented for fetal anomaly scan during the study period. Twenty-nine anomalies (9.9%) were detected among the scanned population. Sixteen of the anomalies were followed to delivery/termination with a specificity of 93.5%. The commonest malformations were demonstrated in the genitourinary tract (34.5%) followed by malformations within the central nervous system (27.6%). Six (20.6%) of the anomalies were lethal. Five of the anomalies were surgically correctable.

Conclusion:

Institutions and hospitals across Nigeria and other low- and middle-income countries need to develop policies and programs that would incorporate a standardized routine screening prenatal US in order to improve feto-maternal well-being and reduce the high perinatal mortality and morbidity in developing nations.     

光电探测系统与细胞学检测在宫颈癌筛查中的对照研究

目的 探讨光电探测系统(TS)与细胞学检测在宫颈癌筛查中的临床意义.方法 对392例患者依次进行TS、巴氏涂片(Pap)、液基薄层细胞学检测(TCT)及人类乳头状瘤病毒(HPV)检测,以阴道镜和病理学检查为金标准,比较4种方法及联合方法的灵敏度、特异度、Kappa值和应用受试者工作特征曲线(ROC)的曲线下面积.结果 (1)Pap、TCT、TS及HPV检测的灵敏度分别为32.2%、42.2%、74.4%和47.8%,特异度分别为96.7%、93.7%、78.8%和84.8%.TCT并联HPV、TCT并联TS、Pap并联TS、HPV并联TS的灵敏度分别为65.6%、87.8%、82.2%和86.7%,特异度分别为81.1%、74.5%、75.8%和67.2%.(2)比较ROC曲线下面积,TS与Pap、TIS与HPV检测有统计学差异(P＜0.05),而TCT与Pap、TCT与TS没有统计学差异;使用并联筛查方法时,TS并联其他方法与相应非TS方法比较,有统计学差异(P＜0.05),但与单独使用TS相比,无统计学差异,四种并联方法之间无统计学差异.结论 (1)TS作为一种宫颈癌早期筛查技术,具有即时检测即时诊断的效果.(2)本研究中TS的诊断效果评价优于Pap及HPV,等同于TCT,TS联合细胞学检测可以提高细胞学检测的筛查效果.     

城市医院宫颈癌机会性筛查初步研究

目的 探讨在城市医院进行宫颈癌机会性筛查的价值.方法 收集分析2008～2009年重庆市肿瘤研究所门诊进行宫颈癌机会性筛查的资料,筛查方法包括液基细胞学(TCT)、巴氏细胞学、高危型人乳头瘤病毒(HPV)、DNA检测,以及中国癌症基金会推荐的Ⅰ方案(TCT检查加高危型HPV-DNA检测)、Ⅱ方案(巴氏涂片加高危型HPV-DNA检测)、Ⅲ方案(醋酸白肉眼检查法)等;并经阴道镜检查,病理确诊宫颈病变及宫颈癌.结果 共收治门诊患者22 213例次,其中接受机会性筛查3 514例,占门诊例次16.81%.最普遍采用的筛查方法是细胞学检查(TCT及巴氏细胞学方法),占91.4%,检出宫颈癌前病变(CINⅠ+CINⅡ+CINⅢ)共79例(2.25%),宫颈癌3例(0.1%).结论 城市医院内就诊人群宫颈病变检出率高,TCT在宫颈病变的筛查中起重要作用,应重视其机会性筛查,及时进行规范性治疗.     

宫颈癌扩大筛检计划的成本效益分析

目的：探讨扩大宫颈癌筛检覆盖率计划是否具有成本效益。方法：利用浏阳市11年来的宫颈癌普查资料和浏阳市公共卫生综合试点调查资料,对现行的宫颈癌筛检和扩大筛检覆盖率的方案进行比较和成本效益分析。结果：采取扩大筛检计划后,浏阳市30~59岁已婚妇女的筛检覆盖率从7.20%上升至66.67%（u=17.84, P＜0.001）,每周期早期发现病例从20例增加到45例,避免减寿命年数从103.46增加至925.83个生命年。成本效益分析提示：多挽救1个寿命年平均需花费6 917.07元。从筛检的成本效益比来看,筛检覆盖率为66.67%时的效益成本比为1.80∶1,高于常规筛检的效益成本比1.40∶1,且两种方案均有较好的成本效益。 结论：通过强化宣传,提前通知等方式,提高宫颈癌筛检的覆盖率,具有较好的成本效益。     

宫颈刮片脱落细胞学检查在宫颈癌普查中的作用

目的:探讨宫颈刮片脱落细胞学检查在宫颈癌筛查中的作用。方法:回顾性分析行宫颈刮片脱落细胞学检查的5 801例妇女临床资料,分析宫颈刮片脱落细胞学检查结果异常受检者的病理学诊断结果以及各年龄段受检者宫颈病变的情况。结果:5 801例中,2 799例未见核异质细胞,2 914例有轻度核异质细胞,88例有轻度不典型增生细胞。其中45~55岁年龄段受检者检查异常率最高,为1.79%（61/3 413）。80例为轻度不典型增生细胞,5例为重度不典型增生细胞,3例发现癌细胞。88例宫颈刮片脱落细胞学检查异常的受检者中,发生宫颈上皮内瘤变的有13例。结论:宫颈刮片脱落细胞学检查是宫颈癌普查的首选方法,可早期发现宫颈癌癌前病变,有利于早期实施干预,降低宫颈癌的患病率。     

Congenital diaphragmatic hernia in a developing country

INTRODUCTION: Outcome of neonates with congenital diaphragmatic hernia (CDH) varies widely and the data from developing countries is scanty. We aimed to study the management and outcome of CDH. We also aimed to ascertain prenatal and postnatal factors affecting the outcome. METHODS: A retrospective review of neonates with CDH admitted to a teaching hospital was conducted. Demographical data, prenatal and postnatal factors, birth details, management and outcomes were studied. Survival was the primary outcome. RESULTS: 16 live-born neonates with diaphragmatic hernia were admitted during the study period. All neonates had hernia on the left side. Mean (standard deviation) gestational age and birth weight were 38.6 (1.5) weeks and 2,616.6 (457) g, respectively. Polyhydramnios was associated in one patient, and additional anomalies in five patients (31.3 percent). Overall survival was 56.3 percent. The CDH was detected prenatally in four and postnatally in 12 patients. 12 neonates underwent surgery and nine survived. Prenatally-detected cases had significantly reduced survival to surgery, overall survival and lower Apgar scores at one minute (p-value is less than 0.04). Median age at surgery was 48 hours. Average duration of mechanical ventilation among survivors was 91.5 hours. Neonatal intensive care unit stay ranged from five to 27 (median nine) days. Six of seven deaths occurred within 72 hours of life. Non-survivors had significantly low Apgar scores and were symptomatic within 12 hours of life (p-value is less than 0.03). CONCLUSION: Greater than 50 percent survival of neonates with CDH was observed in a centre with conventional ventilation. Poor outcome is likely in neonates who present within 12 hours of life.     

Investigation of non-responders at a cervical cancer screening clinic in Manchester

Uptake of cervical cytology screening in a Manchester practice has been very low (14%) in spite of the family practitioner committee introducing a call and recall system. A questionnaire was used to investigate the attitudes of non-responders, who were all from social classes IV and V. Attendance was found to be inhibited by a high level of anxiety about the test and about cervical cancer, by erroneous beliefs, and by concurrent family difficulties. More than half the non-attendance was directly attributable to administrative errors, which resulted in appointments being sent to wrong addresses or to inappropriate people (four after hysterectomy, 10 who had had recent smears). These matters require urgent attention. Several simple measures might improve attendance at clinics, follow up of patients, and attitudes toward screening: invitations to attend the clinic, a register of patients and results, a simpler version of the leaflet, use of well known personalities to promote cervical screening, health education campaigns, and regular evaluation of records.