147例老年妇女阴道出血临床分析

目的探讨老年妇女阴道出血的病因及发病特点。方法收集147例在本院妇产科就诊的≥60岁妇女阴道出血的临床资料,分析其阴道出血的原因和发病特点。结果良性病变是老年妇女阴道出血的主要原因（76．9％）,以老年性阴道炎居首位（26．5％）;恶性肿瘤占23．1％,以子宫内膜癌为主。结论生殖器炎症是老年妇女阴道出血最主要的原因,随着绝经年限的延长,恶性肿瘤发生的危险性逐渐增加。     

绝经后阴道出血合并宫颈癌的危险因素

目的探讨绝经后阴道出血合并宫颈癌的危险因素。方法采用多因素Logistic分析影响绝经后阴道出血患者139例合并宫颈癌危险因素,调查患者临床资料,包括绝经后年限、孕次、绝经至出血年限、阴道出血持续时间、人乳头瘤病毒(HPV)感染、合并高血压、合并糖尿病、吸烟、饮酒、宫内环、子宫内膜厚度。结果 139例绝经后阴道出血患者中,合并宫颈癌患者38例,未合并宫颈癌患者101例。两组绝经后年限、合并高血压、合并糖尿病、吸烟、饮酒和宫内环比较无统计学差异(P>0.05);合并宫颈癌组孕次≥2次、绝经至出血年限≥8年、阴道出血持续时间≥14 d、HPV感染、子宫内膜厚度≥4 mm比例明显多于未合并宫颈癌组(P<0.05)。多因素Logistic回归分析,绝经至出血年限≥8年、阴道出血持续时间≥14 d、HPV感染和子宫内膜厚度≥4 mm为影响中老年绝经后阴道出血合并宫颈癌危险因素。结论绝经后阴道出血合并宫颈癌的危险因素较多,其中绝经至出血年限、阴道出血持续时间、HPV感染、子宫内膜厚度为其危险因素。     

阴道超声、宫腔镜及内膜活检在绝经后阴道出血诊断中的价值

目的 比较经阴道超声（TVS）、宫腔镜和子宫内膜活检在绝经后阴道出血患者诊断中的作用，为绝经后阴道出血患者早期发现子宫内膜癌找到最适合的诊断方法。方法 通过回顾性分析我院2005年1月至2006年12月收治的300例绝经后阴道出血的患者的临床资料，分别计算TVS、宫腔镜和诊断性刮宫取内膜活检诊断子宫内膜癌的灵敏度、特异度、阳性预测值、阴性预测值及ROC曲线下面积，并比较三者对子宫内膜癌的诊断价值。结果 在TVS检测子宫内膜〈4mm中，经组织病理学确诊1例（1／19）为子宫内膜癌。在子宫内膜≥4mm中，术后经组织病理学确诊26例（26／281）为子宫内膜癌。如果以子宫内膜≥4mm为临界值，TVS的灵敏度和特异度分别为96．15％和6．57％，阳性预测值8．90％，阴性预测值94．73％（ROC曲线下面积：0．726）。以子宫切除术后病理诊断为黄金标准，宫腔镜的灵敏度和特异度分别为100％和98．54％，阳性预测值86．67％，阴性预测值100％（ROC曲线下面积：0．982）；内膜活检的灵敏度和特异度分别为96.3％和100％，阳性预测值100％，阴性预测值99．0％（ROC曲线下面积：0．999）。结论 TVS以4mm为临界值对绝经后刚道出血患者诊断内膜癌的灵敏度较高，但对于子宫内膜厚度〈4mm的，可能会漏诊子宫内膜癌。对于绝经后阴道出血的患者都应该进行宫腔镜检查和内膜诊刮。     

绝经后患者发生子宫内膜息肉的危险因素分析

［摘要］　目的　分析绝经后患者发生子宫内膜息肉的危险因素。方法　回顾性分析民航总医院妇产科2022年1月1日至2023年12月31日收治的310例绝经后子宫内膜增厚（内膜厚度≥4 mm）患者的临床资料,均行超声检查后实施宫腔镜手术。根据术后病理结果分为子宫内膜息肉组134例,非子宫内膜息肉组176例。比较两组患者临床资料,应用多因素logistic回归分析绝经后患者子宫内膜息肉发生的危险因素。结果　两组年龄、孕次、产次、剖宫产次数、子宫内膜厚度以及合并糖尿病、肥胖的人数比例比较差异无统计学意义（P>0.05）,两组合并高血压、阴道出血及子宫内膜炎的人数比例以及绝经时间比较差异有统计学意义（P<0.05）。多因素logistic分析结果显示,子宫内膜炎、阴道出血以及较长的绝经时间是绝经后患者发生子宫内膜息肉的危险因素。子宫内膜息肉发生恶变者3例,年龄均>60岁,绝经时间均>5年。结论　合并子宫内膜炎、阴道出血及较长绝经时间的绝经后患者发生子宫内膜息肉的风险较高。     

宫腔镜检查对70例绝经后子宫出血者的病因分析

目的前瞻性研究门诊绝经后子宫出血的原因。方法对绝经后子宫出血患者行宫腔镜检查，对可疑病灶行活检术和（或）诊刮术，以病理结果作为病因诊断的的依据。结果７０例绝经后子宫出血患者的出血原因为：子宫内膜萎缩出血及子宫内膜炎共３２例（４５．７％）；子宫内膜增殖症１４例（２０％）；子宫内膜癌８例（１１．４％）；子宫内膜息肉８例（１１．４％）；其他原因８例（１１．４％）。结论子宫内膜萎缩出血及子宫内膜炎是绝经后子宫出血的主要原因，宫腔镜检查是绝经后子宫出血的可靠诊断方法。     

阴超检测用三苯氧胺治疗绝经后妇女子宫内膜病变的作用

目的 评估用三苯氧胺（Tamoxifen TAM)作为辅助治疗的绝经后乳腺癌妇女,阴超测量其子宫内膜厚度的价值。方法 研究82例患乳腺癌的绝经后妇女,用TAM辅助治疗6月以上的超声检查结果,子宫内膜厚度以两层厚度计算,将内膜厚度≥5mm作为绝经后妇女异常的标准,作为膜活检。结果 82例中22例（28．1％）有阴道流血症状,所有这些病人阴超子宫膜厚度均超过5mm。子宫内膜厚度超过9mm的妇女,内膜有异常组织学发现的比例显示高于内膜厚度低于9mm的妇女（前63．6％,后6．1％,P＜0．001）。子宫内膜厚度＞9mm,同时有阴道流血,将预示子宫内膜有病变。结论 使用TAM的绝经后妇女,阴超子宫内膜厚度超过9mm,同时存在阴道流血是子宫内膜病变的重要信号,必须作内膜活检。鉴于检测子宫内膜的敏感性达86．9％,可见阴超用于研究用TAM治疗的绝经后妇女子宫内膜的变化是十分有效的。     

经阴道超声、宫腔镜检查在绝经后阴道流血病因诊断中的价值

目的探讨经阴道超声（TVS）、宫腔镜检查在绝经后阴道流血（PMB）病因诊断中的价值。方法分析210例PMB患者的TVS和宫腔镜检查结果,并与病理检查结果作对比分析。结果TVS和宫腔镜检查并经病理检查确认,PMB的病因中子宫内膜良性病变占86．67％、子宫恶性肿瘤占13．33％。TVS诊断子宫内膜异常的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为99．16％、51．65％、72．84％、97．92％及78．57％,宫腔镜分别为100％、91．21％、93．70％、100％及96．19％。结论TVS及宫腔镜对PMB病因诊断的敏感性都很高,宫腔镜的特异性高于TVS。     

老年妇女阴道出血207例临床分析

目的　探讨绝经后老年妇女阴道出血患者的诊断及治疗。　方法　分析 2 0 7例 6 0岁以上绝经后出血患者的临床资料、超声检查、CA12 5值和术后病理结果。　结果　恶性肿瘤引起的绝经后出血在 6 0～ 6 9岁组中占 2 1 5 % ,70～ 84岁组中占 2 8 6 %。子宫内膜不典型增生占全部病例的8 2 %。进行手术者在 6 0～ 6 9岁组中占 74 5 % ,70～ 84岁组中占 6 0 5 %。术后总的并发症为19 7% ,超声检查子宫内膜厚度≥ 5mm作为预测子宫恶性病变的敏感性为 87 2 % ,特异性 84 1% ,CA12 5值 >2 0IU/ml作为预测子宫恶性病变的特异性为 75 3% ,敏感性为 4 0 0 %。　结论　老年绝经后出血患者恶性肿瘤的发病率平均为 2 4 2 % ,超声检查和CA12 5值在诊断中有重要意义 ,老年妇女施行手术仍然是安全可行的。     

绝经后阴道出血患者子宫内膜变化及临床意义

绝经后阴道出血临床常见 ,常见原因为子宫肌瘤、宫腔内良恶性病变及炎症等。为提高宫腔内病变的确诊率 ,我们采用经阴道超声及宫腔镜或诊断性刮宫对 6 3例绝经后阴道出血患者的子宫内膜进行了观察 ,现将结果报告如下。资料与方法 :本组年龄 5 2～ 72岁 ,平均 6 1岁 ,门诊检查已     

绝经后阴道出血486例原因分析

对486例绝经后阴道出血患者的临床资料进行回顾性分析。认为引起绝经后阴道出血最常见的原因是生殖器炎症,老年、绝经时间愈长者,恶性肿瘤发生率愈高。     

Effects of raloxifene on other organs without bone: uterus

Tamoxifen and Toremifene act as agonistic on uterine myometrium and endometrium. Tamoxifen leads re-enlargement of uterine myomas, recurrence of adenomyosis, atypical genital bleeding for endometrial hyperplasia and endometrial carcinoma in postmenopausal women. Therefore, it is necessary to evaluate the stage of pathological change on myometrium and endometrium, both before and during the period of administration of tamoxifen or toremifene. Unlike these drugs, raloxifene has an antagonistic action on uterine myometrium and endometrium. From these standpoints, we consider that raloxifene use lower the risks of uterine myomas, adenomyosis, endometrial hyperplasia and endometrial carcinoma.     

Geriatric gynecologic problems increasing

Over a 3-year period, the percentage of geriatric patients with gynecologic problems treated in one Canadian hospital almost doubled. Pelvic pain, uterine bleeding, and voiding problems were the most common symptoms. Concomitant diseases existed in 60% of the patients, with cardiac and pulmonary problems the most frequent. Uterine fibroids and genital cancer were the most common pathologic diagnoses. Hysterectomy was part of the operative procedure in 37 of 50 patients, and these operations required more time and longer postoperative hospitalization than others. Complications developed in 24% of the patients, with cellulitis, phlebitis, and fever seen most often.     

Herpes Simplex Virus Genital Infections: Current Concepts

Genital herpes is a common sexually transmitted disease that is frequently undiagnosed. Viral shedding occurs frequently and often without symptoms facilitating transmission to sex partners. Genital herpes may impact HIV transmission, and may be transmitted to neonates at the time of birth. Primary prevention of genital herpes is needed to lower the burden of disease.     

Genital human papillomavirus infection.

Genital human papillomavirus (HPV) infection is a common sexually transmitted disease that at the present time is not effectively controlled or treated. Many infections are inapparent and transient. However, some HPV infections result in persistent lesions that in some cases undergo carcinogenic progression. A subset of genital HPVs, designated high-risk types, are preferentially associated with high-grade dysplasias and carcinomas. About 90% of cervical cancers contain high-risk HPV DNA, most often HPV16. Development of a subunit vaccine against high-risk genital HPVs is a desirable and, it appears, an increasingly feasible long-term goal. The viral E6 and E7 oncoproteins are selectively maintained and expressed in progressed HPV tumors and could potentially be targets for therapeutic vaccines. The L1 major virion structural proteins have recently been shown to self-assemble into virus-like particles when expressed in insect cells. These particles might serve as the basis for a prophylactic vaccine to prevent genital HPV infection.     

中老年妇女子宫异常出血的原因

目的　探讨中老年妇女子宫异常出血的原因 ,以利早期发现恶性子宫体肿瘤。方法　应用刮宫术结合B型超声和宫腔镜检查分析了 1 685例年龄 >40岁的子宫异常出血病例 ,并对部分手术病例的临床和病理特点进行了研究。结果　 56 0 %的围绝经期 ,41 7%的绝经后期和40 6 %的老年期子宫异常出血患者有子宫内膜增生。老年期患者患不典型增生和复杂性增生的比例明显高于围绝经期和绝经后期患者 ,绝经后期高于围绝经期患者 (均P <0 0 1 )。老年期和绝经后期子宫体恶性肿瘤患病率明显增高 (P <0 0 1 )。子宫内膜鳞癌无论在老年期还是在围绝经期都有较高的患病率 (>1 2 % )。结论　子宫内膜增生和子宫内膜癌是中老年妇女子宫异常出血的主要原因 ,非腺癌有逐年增加的倾向     

Schistosoma mansoni: a rare cause of tubal infection

S. haematobium is an important cause of urinary schistosomiasis, and symptomatic female genital infection is a common gynecological finding in areas where S. haematobium is prevalent. On the other hand, genital manifestations of intestinal schistosomas as S. mansoni are not frequent or are misdiagnosed. A case of a 40-year-old woman with abnormal uterine bleeding and asymptomatic tubal infection by S. mansoni identified in histological examination is presented.     

Simple clinical manifestations of genital Schistosoma haematobium infection in rural Zimbabwean women

Up to 75% of women with urinary schistosomiasis have Schistosoma haematobium ova in the genitals. This study aimed to describe the prevalence of gynecologic S. haematobium infection and to differentiate the disease from sexually transmitted infections (STIs). Gynecologic and laboratory investigations for S. haematobium and STIs were performed in 527 women between the ages of 20 and 49 in rural Zimbabwe. Genital homogenous yellow and/or grainy sandy patches, the commonest type of genital pathology, were identified in 243 (46%) women. Grainy sandy patches were significantly associated with S. haematobium ova only. Genital S. haematobium ova was also significantly associated with homogenous yellow sandy patches, mucosal bleeding, and abnormal blood vessels. The presence of ova was not a predictor for ulcers, papillomata, leukoplakia, polyps, or cell atypia. Mucosal sandy patches seem to be pathognomonic for S. haematobium infection in the female genitals. Coexistence of ova and other lesions may not be causal.     

Genital human papillomavirus infection in men: incidence and risk factors in a cohort of university students

BACKGROUND: In contrast to the wealth of data on human papillomavirus (HPV) infections in women, much less is known about HPV in men. METHODS: Between June 2003 and March 2006, a total of 240 heterosexually active male university students 18-20 years of age were recruited for participation in a cohort study of HPV infection. Genital cell samples were collected, at 4-month intervals, for HPV-DNA analysis by polymerase chain reaction. The subjects maintained a Web-based journal of sexual activity. RESULTS: At 24 months, the cumulative incidence of new infection of any genital HPV type was 62.4% (95% confidence interval [CI], 52.6%-72.2%). Acquisition rates did not differ by genital site (i.e., glans, penile shaft, or scrotum) of initial detection (P=.86). The most commonly detected types were HPV-84 and HPV-16. In multivariate analysis, a report of a new sex partner during the prior 0-4 (hazards ratio [HR], 2.0 [95% CI, 1.3-3.0]) and 5-8 (HR, 1.8 [95% CI, 1.2-2.7]) months and a history of smoking (HR, 1.6 [95% CI, 1.1-2.4]) were associated with an elevated risk of HPV acquisition. CONCLUSION: Genital HPV infection is common and multifocal in young men, and its incidence is higher than that reported for similar cohorts of young women. The high rates of HPV infection in men should be considered when strategies for the prevention of HPV infection in female adolescents and young women are being developed.