早期宫颈癌宫旁组织转移的临床特点及危险因素分析

目的探讨早期宫颈癌宫旁组织转移患者临床特点及危险因素。方法回顾性分析太和医院收治的900例ⅠA2~ⅡA2期早期宫颈癌患者的临床资料,所有患者入院后均接受广泛性子宫切除联合盆腔淋巴结清扫术,统计宫颈癌宫旁组织转移例数,总结患者临床特点,分析早期宫颈癌患者宫旁转移的危险因素。结果 (1)900例早期宫颈癌患者发生宫旁组织转移55例,转移率为6.11%,以宫旁软组织转移率最高(3.11%),宫旁脉管次之(1.67%);(2)单因素分析发现:宫颈癌患者发生宫旁组织转移与患者临床分期、肿瘤最大直径、鳞状细胞癌抗原(SCC-Ag)水平、肿瘤浸润深度、脉管浸润、手术切缘、淋巴结转移、累及宫体、累及阴道均有其相关性(P0.05);(3)多因素分析发现:浸润深度、脉管侵犯、手术切缘、淋巴结转移是早期宫颈癌患者发生宫旁组织转移的独立危险因素(P0.05),其中淋巴结转移相关度最高。结论早期宫颈癌患者宫旁组织转移发生率较低,肿瘤浸润深度、脉管侵犯、手术切缘阳性、淋巴结转移均为宫颈癌患者发生宫旁组织转移的危险因素。     

宫颈癌宫旁浸润150例相关因素分析

目的通过分析宫颈癌宫旁浸润与各临床病理因素的关系,探讨影响宫颈癌宫旁浸润的高危因素。方法收集乐山市人民医院行手术治疗的150例临床IA-IIB期宫颈癌患者的临床病理资料,将宫旁浸润与各临床病理因素之间的关系进行单因素χ2检验及多因素logistic回归分析。结果宫颈癌宫旁浸润率为16.7%(25/150)。单因素分析显示临床分期、间质浸润深度、肿瘤生长方式、肿瘤直径、淋巴结转移与宫旁浸润间具有相关性(P0.05);多因素分析显示仅肿瘤生长方式、间质浸润深度、淋巴结转移与宫旁浸润相关。结论肿瘤生长方式、间质浸润深度、淋巴结转移为宫旁浸润的高危因素。     

宫颈癌淋巴结转移危险因素分析

目的:探讨与宫颈癌淋巴转移相关的危险因素,预测宫颈癌淋巴转移风险,找出影响预后因素.方法:以齐齐哈尔医学院附属第一、二、三医院确诊的96例宫颈癌患者的资料进行宫颈癌淋巴结转移危险因素分析.结果:宫颈癌的淋巴结转移与肿瘤病理分级、临床分期、浸润深度及肿瘤直径等方面有直接关系.结论:肿瘤的病理分级、临床分期、浸润度、肿瘤大小等方面是宫颈癌淋巴结转移的独立影响因素.     

核磁共振在术前诊断宫颈癌宫旁浸润和淋巴结转移中的意义

目的为了深入分析核磁共振（MRI）对于宫颈癌宫旁浸润和淋巴结转移在手术之前诊断的准确性。方法对68例宫颈癌患者在手术之前进行MRI扫描,并将MRI扫描的结果与手术之后的病理结果进行对比。结果从总体的效果上看,MRI的扫描结果与术后病理结果的综合匹配率为82.35%,临床分期与术后病理结果的综合匹配率为67.65%。在预测宫颈癌宫旁浸润方面,敏感性、特异性和准确性分别为87.88%、93.27%和91.97%;MRI在预测淋巴结转移方面,敏感性、特异性和准确性分别为57.62%、94.26%和86.59%。结论 MRI扫描结果能清晰显示宫颈癌宫旁浸润深度和淋巴结转移情况,对于宫旁浸润的预测效果要好于临床分期。因此,MRI扫描是宫颈癌治疗的重要辅助手段,在宫颈癌手术之前应进行MRI扫描,提升治疗的效果,也为选择最合适的治疗手段提供科学的依据。     

核磁共振在术前诊断宫颈癌宫旁浸润和淋巴结转移中的意义

目的:探讨核磁共振在术前诊断宫颈癌宫旁浸润和淋巴结转移中的意义。方法:选择海南省人民医院2004年1月～2009年11月宫颈癌手术治疗患者155例,对其进行核磁共振检查,分析其核磁共振图像特点,判断分期并与手术病理分期及临床分期结果相比较。结果:①术前MRI分期与术后病理分期比较,总体符合率为82.58%。②临床分期与术后病理分期比较,总体符合率为62.58%。③MRI分期预测宫颈癌宫旁浸润敏感性为80.64%,特异性为90.32%,准确性88.39%;MRI分期预测宫颈癌淋巴结转移敏感度为55.17%,特异性为95.24%,准确性为87.74%。结论:MRI可直观显示肿瘤,准确判定肿瘤体积、浸润深度及淋巴结转移情况,在判断宫旁浸润方面优于临床分期,是临床分期的重要补充,在手术前应常规进行MRI检查。     

MRI术前诊断宫颈癌宫旁浸润和淋巴结转移中的价值研究

目的:探讨宫颈癌患者术前采用核磁共振(MRI)检查对宫颈癌宫旁浸润和淋巴结转移判定的临床价值。方法:选择2011年5月~2014年5月在该院实施宫颈癌手术治疗的120例患者术前进行MRI检查,比较MRI预测患者宫颈癌分期与术后病理分期的一致性,术前MRI诊断宫旁浸润与淋巴结转移与术中结果比较的差异。结果:MRI检查共正确诊断ⅠA期11例、ⅠB期33例、ⅡA期36例、ⅡB期11例、ⅢB期4例、ⅣA期4例。术前MRI检查结果与术后病理检查结果的诊断符合率为82.50%(99/120)。MRI检查结果与术后病理检查结果的一致性Kappa=0.774,P=0.000。120例患者术中共发现17例淋巴结转移,术前MRI检查判定出13例淋巴结转移患者,术前MRI检查诊断淋巴结转移的灵敏度70.59%,特异度99.03%,误诊率0.97%,漏诊率29.41%,诊断一致率Kappa=0.772,P=0.000。术前MRI检查诊断13例宫旁浸润患者,术后病理证实的有10例,MRI检查宫旁浸润的灵敏度100%,特异度97.27%,误诊率2.73%,漏诊率0,诊断一致率Kappa=0.856,P=0.000。结论:MRI术前检查宫颈癌可以对宫颈癌分期做出较为准确的判定,对诊断淋巴结转移、宫旁浸润与病理诊断具有较高的一致性。     

宫颈癌根治术后并发肺转移的危险因素分析

目的研究宫颈癌根治术后并发肺转移的危险因素。方法选取2014年2月-2017年10月,于山东省妇幼保健院接受宫颈癌根治术治疗后并发肺转移的患者78例记为转移组,另取同期于该院接受宫颈癌根治术治疗后未并发肺转移的患者100例记为未转移组。分别比较两组临床病理特征情况、淋巴结转移情况以及宫旁或切缘阳性与否、术前血清肿瘤标志物表达水平情况。并作多因素logistic回归分析。结果转移组患者肿瘤直径>4 cm、非鳞癌、间质浸润深度达至外膜层人数占比分别为61. 54%(48/78)、21. 79%(17/78)、38. 46%(30/78),均明显高于未转移组的23. 00%(23/100)、6. 00%(6/100)、12. 00%(12/100),组间对比差异均有统计学意义(均P<0. 05)。转移组患者盆腔淋巴结转移人数占比为44. 87%(35/78),明显高于未转移组的16. 00%(16/100),组间对比差异有统计学意义(P<0. 05)。转移组患者宫旁或切缘阳性人数占比为12. 93%(10/78),明显高于未转移组的2. 00%(2/100),而术前血清肿瘤标志物表达水平正常人数占比为29. 49%(23/78),明显低于未转移组的57. 00%(57/100),组间对比差异均有统计学意义(均P<0. 05)。经多因素logistic回归分析可得:影响宫颈癌根治术后并发肺转移的因素包括肿瘤直径(OR=1. 657)、非鳞癌(OR=1. 723)、间质浸润深度(OR=2. 375)、盆腔淋巴结转移(OR=1. 983)、宫旁或切缘阳性(OR=1. 844)、术前血清肿瘤标志物表达水平异常(OR=2. 057)。结论肿瘤直径>4 cm、非鳞癌、间质浸润深度达至外膜层、盆腔淋巴结转移、宫旁或切缘阳性、术前血清肿瘤标志物表达水平异常均是宫颈癌根治术后并发肺转移的独立危险因素,值得临床重点关注。     

海淀区宫颈癌发病相关危险因素分析

目的:研究宫颈癌发病的相关危险因素。方法:收集2001~2002年海淀区户籍在北京各大医院就诊并经病理证实为宫颈癌的患者临床资料77例。按照1∶3病例对照配比原则,对照组进行系统的妇科体检,选择在个人、家庭、生活习惯、职业环境、现患史及既往史等进行条件单因素logistic分析。结果:对照组体检确诊宫颈癌一例,子宫内膜癌一例,从对照组剔除,重新选对照,单因素logistic分析显示,结婚次数、怀孕次数、白带多、白带异味、阴道排液、阴道不规则出血为宫颈癌的高危因素。结论:重视高危因素,定期进行妇科体检,为预防宫颈癌的有效方法。     

宫颈癌危险因素的Meta分析

[目的]运用Meta分析方法综合分析评价宫颈癌致病危险因素。[方法]本文收集国内有关宫颈癌危险因素的病例对照研究文献20篇,采用可信区间方差分析法计算各相关因素的ORc及95%CI。[结果]口服避孕药的ORc的95%CI包括1,其他相关因素的ORc的95%CI不包括1。[结论]文化程度、家庭收入、首次性生活年龄、首次怀孕年龄、首次生育年龄、首次结婚年龄、绝经情况和职业是宫颈癌的保护因素,HPV感染、多孕、多产、多婚、性伴数、重大精神创伤、慢性宫颈炎、包皮过长、恶性肿瘤史和吸烟是宫颈癌的危险因素。口服避孕药与宫颈癌关系尚不明确,需进一步研究。吸烟、慢性宫颈炎、多婚、首次生育年龄等因素结果存在较大偏性,与宫颈癌的关系尚需进一步证实。     

宫颈癌患者术后医院感染相关危险因素分析

目的探讨宫颈癌患者术后发生感染的相关危险因素,为减少患者术后感染提供理论依据。方法回顾性分析2010年12月-2012年12月150例宫颈癌患者的临床资料,对发生感染的患者的临床资料进行单因素分析和多因素logistic回归分析,观察发生感染的相关危险因素,采用SPSS17.0软件进行统计分析。结果 150例患者术后发生感染46例,感染率为30.67%,以泌尿系统、阴道残端和盆腔感染为主;单因素分析发现,患者的年龄、病理类型、宫颈癌分期、基础疾病≥3种、化疗药物、术后导尿次数、导尿管留置时间、手术时间以及术后抗菌药物使用等有显著相关性(P<0.05);多因素logistic回归分析显示,患者的年龄、宫颈癌分期、进行化疗治疗、术后导尿次数以及导尿管留置时间等是宫颈癌患者术后发生感染的独立危险因素。结论宫颈癌患者术后发生感染的危险因素较多,应引起高度重视并进行针对性干预处理。     

Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis

Patients with cervical cancer diagnosed with a para-aortic lymph node (PALN) metastasis by computed tomography (CT) scan were analyzed to identify associated prognostic factors. A total of 55 patients were reviewed, and 27 of these patients underwent extended-field radiotherapy (EFRT). The median PALN dose in patients receiving EFRT was 45 Gy (range, 27–57.6 Gy). Of the 55 patients, 28 underwent pelvic radiotherapy (RT); concurrent chemoradiotherapy (CCRT) was administered to 41 patients. The Kaplan–Meier method was used to calculate the actuarial rate. Multivariate analysis was performed using the Cox proportional hazards model. Five-year overall survival (OS) rates were 41% and 17.9% in patients undergoing EFRT and pelvic RT (P = 0.030), respectively. Age < 53 years (P = 0.023), FIGO Stage I–II (P = 0.002), and treatment with EFRT (P = 0.003) were independent predictors of better OS. The use of CCRT (P = 0.014), Stage I–II (P = 0.002), and treatment using EFRT (P = 0.036) were independent predictors of distant metastasis. In patients undergoing EFRT plus CCRT, the 5-year OS was 50%. Three-year PALN disease-free rates were 8.8%, 57.9% and 100% (P < 0.001) in CCRT patients who received PALN doses of 0 Gy, ≤45 Gy and ≥50.4 Gy, respectively. Although PALN metastasis is thought to be distant metastasis in cervical cancer, EFRT plus CCRT shows a good outcome, particularly in younger patients in an early FIGO stage. Cervical cancer with a PALN metastasis should not be considered incurable. Doses ≥50.4 Gy for treating PALN may result in better disease control.     

宫颈癌危险因素研究进展

宫颈癌是最常见的女性生殖道恶性肿瘤,人乳头瘤病毒感染、端粒和端粒酶的激活、人类白细胞抗原的改变、性传播疾病的发生等均与宫颈癌的发生发展相关,针对这些危险因素进行干预可有效地降低宫颈癌的发病率.本文对近年来宫颈癌发生相关因素的研究作一综述.     

山西省襄垣县宫颈癌危险因素分析

目的：在宫颈癌高发区调查其危险因素,为现阶段宫颈癌的防治工作提供依据。方法：在宫颈癌高发区山西省襄垣县,对1997年妇女采用6种宫颈癌检查方法筛查后,进行问卷调查,卷卷内容包括：基本信息,月经婚孕史,性行为及卫生习惯,避孕史,既往疾病和肿瘤家族史等,进行高危型人乳头瘤病毒（HPV）检测,病理学诊断为宫颈高度鳞状上皮病变以上者86例,非癌及非鳞状上皮病变者共1784例作为对照.结果：高危型HPV感染率为20．8％（415／1997）,病例组HPV感染率为97．7％,而对照组为14．2％,单因素分析后,具有显著统计意义的变量有：高危型HPV感染,初次性交年龄,流产史,性伴侣数,怀孕治疗史及肿瘤家族史等。logistic回归分析结果表明,高危型HPV感染,性伴侣数和肿瘤家族史与宫颈癌的发生呈显著关联,此外,HPV感染与男,女婚外性行为均有显著的统计学联系,且随性伴侣数呈趋势性增高,结论：襄垣县妇女子宫颈癌高发的主要危险因素是高危型HPV感染。HPV感染与该地区性生活,月经期及产褥期卫生不洁有直接关联。     

宫颈癌危险因素的流行病学调查

目的:探讨宫颈癌的危险因素。方法:采用成组病例对照研究设计。从医院收集99人确诊的宫颈癌病例,以年龄为匹配条件,从体检中心选择对照。设计问卷,面访调查。结果:居住地、受教育程度、经济收入、孕次、食用腌制食品、被动吸烟、性生活后阴道冲洗等变量进入回归模型。结论:社会经济地位、多孕次、常吃腌制食品、性生活卫生等因素与罹患宫颈癌有关。     

妊娠合并亚临床甲状腺功能减退症相关危险因素分析

目的探讨妊娠合并亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)的相关危险因素。方法选取2013年11月至2015年12月在成都市妇女儿童中心医院妇产科住院分娩的妊娠合并SCH患者519例为研究组,同期540例非SCH孕产妇为对照组,采用面对面询问和问卷调查方式收集两组的一般资料、本次怀孕前及孕期情况、既往妊娠史等,分析影响妊娠合并SCH的危险因素。结果相关单因素分析结果显示:年龄、孕产史、家庭人均月收入、文化程度、自然流产史、剖宫产、孕前体质量指数(body mass index,BMI)为影响妊娠合并SCH的单因素(P0.05);Logistic回归分析结果显示:年龄≥30岁、初产者、孕前BMI18.5 kg/m~2为影响妊娠合并SCH的危险因素(P0.05)。结论妊娠合并SCH的发生与孕妇年龄、孕产史、孕前BMI相关。     

Limited Pap screening associated with reduced risk of cervical cancer in South Africa

BACKGROUND: We investigated the effect of Pap smear screening on the incidence of invasive cancer of the cervix in the Western Cape, South Africa where screening is limited. METHODS: Data were derived from a case-control study of the association of hormonal contraceptives and invasive cervical cancer. Incident cases (n = 524) of invasive cervical cancer who presented at two tertiary hospitals and controls (n = 1540) series matched for age, race, and place of residence were interviewed. Information on a wide range of variables was collected including whether the women had previously had a Pap smear taken and the number and timing of smears. Odds ratios (OR) and 95% CI were calculated using multiple logistic regression. RESULTS: The OR of cervical cancer was reduced among women who had ever had a smear (OR = 0.3, 95% CI: 0.3-0.4). The OR declined with increasing number of smears to 0.2 for >/=>3 smears (trend P = 0.0003). Among women who had a smear <5 years previously the OR was 0.3, but even if the smear was taken >/=15 years previously the women remained at reduced risk (OR = 0.5). CONCLUSION: The data suggest that even limited Pap smear screening reduces the risk of cervical cancer. Should a screening programme be successfully implemented, the incidence of cervical cancer might be reduced by as much as 70%.     

Reproductive risk factors associated with breast cancer in Colombian women]

INTRODUCTION: As of 1992, breast cancer has been the second cause of death in Columbian women, with a rising trend in mortality due to this type of neoplasm (average annual rate 4.5*/100.000 inhabitants). Information about potential risk factors for breast cancer in Latin American countries is scarce. The objectives of the project were to test the breastfeeding protection against breast cancer and to establish the reproductive factors associated with breast cancer in Columbia. METHODS: A hospital case-control study was carried out from July 1995 to March 1996 in Bogotá, Columbia, using paring by age groups. The study population consisted of 171 histopathologically confirmed cases and 171 controls. Reproductive history and sociodemographic data were collected through a questionnaire, and logistic regression models were used for statistical analysis of the data. RESULTS: The following associated factors were found as principal results: nuli-parousness as compared with women with over 3 children (OR=3.35 CI 1.40-8.0), age at first birth (OR=1.83 CI 0.70- 4.80), breast cancer history, breastfeeding the first child (OR=0.09 CI 0.01-0.64 for 1-11 months) and with a highly significant trend for accumulated breastfeeding above 24 months (p=0.001). CONCLUSIONS: This study indicates the importance of focusing on the promotion of prolonged breastfeeding by women identified as being at higher risk, and confirms that socio-economic level can determine life styles and reproductive events among women (such as breastfeeding time); this could explain the increase in breast cancer mortality in Latin American countries, similar to that in developed countries in terms of fertility and risk factors for breast cancer. The epidemiological information produced by this study will be useful for planning and carrying out early diagnosis and treatment of breast cancer in women identified as being at high risk of this disease.     

Analysis of risk factors associated with nosocomial bacteraemias.

A prospective study of 2676 blood cultures was performed to identify the factors associated with clinically, significant nosocomial bacteraemia that occurred during a one year period in the Malaga University Clinical Hospital. Three hundred and fifty-five episodes of bacteraemia were considered clinically significant. The overall incidence of bacteraemia was 19.5/1000 admissions, of which 46% were hospital-acquired. A multivariate model showed that only six factors were significantly, and independently, responsible for nosocomial bacteraemias: intravascular catheterization (P < 0.0001, OR = 18.37), invasive procedures (P < 0.0001, OR = 10.38), malignancy (P = 0.035, OR = 3.11), indwelling devices (P = 0.005, OR = 3.05), stay in intensive care or surgical departments (P = 0.05, OR = 2.63) and length of hospital stay (P = 0.051, OR = 1.02). These results show that the factors which had most influence on the development of nosocomial bacteraemias were those factors associated with the treatment received by patients during their hospital stay.     

宫颈癌危险因素病例对照研究

目的 探讨宫颈癌高发区的相关危险因素。方法 采用以住院患者为基础的病例对照研究方法，对129名经病理确诊的宫颈癌患者和143例非肿瘤病人对照进行有关月经、婚育史、性行为与避孕史、个人卫生习惯等因素的调查。结果 在单因素分析的基础上进行多元Logistic回归分析，最终引入回归方程的变量为家庭经济收入、首次性交年龄、洗澡设施、妇科病史、产次和绝经，而结婚年龄、首次发生性行为和孕育年龄、孕产次等生殖因素，则与宫颈癌发生的危险性呈剂量一反应关系。结论 经济收入低、首次发生性行为的年龄小、既往有妇科病史、孕产次多可增加宫颈癌发生的危险性，特别值得注意的是洗澡和清洗阴部少等不洁卫生习惯可能是导致当地该病高发的原因之一，绝经后妇女宫颈癌发生的危险性较低。