阴道镜检对宫颈上皮内瘤病变的筛查价值

目的评价阴道镜检对子宫颈上皮内瘤病变（CIN）的诊断价值。方法2007年3—4月湖北省五峰县妇幼保健院对五峰县直机关已婚妇女进行宫颈癌普查。利用阴道镜检直接观察，宫颈表面病变做出诊断，同时镜下定位活检，以组织病理学诊断为金标准，以评价阴道镜检查对予宫颈癌前病变的诊断价值。结果阴道镜检查502人，宫颈活检131人，组织病理学诊断CIN共26人（5．17％），其中CINⅠ17人（3．38％），CINⅡ7人（1．39％），CINⅢ2人（0．39％），宫颈息肉12人（2．39％）慢性宫颈炎92人（18．32％），阴道镜检查对CIN的诊断符合率为92．30％。结论阴道镜检查是诊断CIN和宫颈癌的一个可靠方法，适合在基层医院使用。     

阴道镜检查对宫颈癌及癌前病变的诊断价值

目的:探讨阴道镜检查在早期宫颈癌及癌前病变诊断中的价值。方法:分析湖北省五峰妇幼保健院阴道镜下活检患者237例临床资料,以病理检查为金标准,其中阴道镜下宫颈活检证实为早期宫颈癌及癌前病变的患者113例,非宫颈癌及癌前病变患者124例。采用诊断试验四格表法分析阴道镜检查的各项评价指标。结果:阴道镜检对宫颈癌及癌前病变诊断灵敏度为80.53%,特异度为83.87%,随病变程度的增加阴道镜诊断阳性率增加。结论:电子阴道镜检查对宫颈癌及癌前病变有很高的诊断价值,可考虑用于宫颈癌的筛查。     

Primary screening for breast diseases among 17618 women in Wufeng area, a region with high incidence of cervical cancer in China

In this study, the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated. From March to August, 2009, 17618 women, from Wufeng area of Hubei province, China, were recruited to screen breast diseases by using breast infrared diagnostic apparatus. Other diagnostic methods, such as B-mode ultrasound, X-ray mam-mography, needle biopsy and pathological examination were, if necessary, used to further confirm the diagnosis. The screening showed that 5990 of 17618 cases (34.00%) had breast diseases, 5843 (33.16%) had mammary gland hyperplasia, 48 (0.27%) had breast fibroadenoma, 11 (0.06%) had breast carcinoma, and 88 (0.50%) had other breast diseases. The peak morbidity of breast cancer was found in the women aged 50-60 ages. The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8, 0.157%) in comparison with that in the subjects younger than 50 years old (n=3, 0.024%) (u=2.327, P<0.05). It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years, while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40. Compared with the patients elder than or equal to 40 years old (n=3289, 27.46%), the morbidity rate of breast diseases was sig-nificantly increased in women less than 40 years old (2648 cases, 47.18%; P<0.001). However, there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453), and both of them were high. There was no significant asso-ciation between the morbidity of breast diseases and cervical cancer. Since the morbidity of breast diseases was higher among young women, more attention should be paid to the screening of breast diseases among young women for early diagnosis.     

宫颈细胞学检查联合阴道镜检查对宫颈病变的诊断价值

目的 评价宫颈细胞学涂片联合阴道镜检查对子宫颈病变的诊断价值.方法 2007年3月-4月五峰妇幼保健院院对五峰县直机关已婚妇女进行宫颈癌普查,行宫颈细胞学涂片联合阴道镜检查对宫颈病变进行筛查,以组织病理学诊断为金标准,对结果进行分析.结果 宫颈涂片检查744例,异常涂片118例(15.86﹪),行阴道镜检134例,126例行阴道镜下活检,病检结果是:子宫颈鳞癌4例(0.53﹪),其中早期浸润癌3例,中期癌1例,CIN32例,其中CIN Ⅰ 19例(2.55﹪),CIN Ⅱ 7例(0.94﹪),CIN Ⅲ 6例(0.80﹪),慢性宫颈炎79例(10.61),鳞状上皮化生11例(1.47﹪),宫颈细胞学涂片诊断CIN符合率为68.75﹪,阴道镜检对CIN的诊断符合率为93.93﹪,两者比较差异有显著性(P＜0.05),阴道镜诊断CIN的敏感性为93.93﹪,特异性为86.53﹪.结论 采用宫颈细胞学检查联合阴道镜下病理检查能及早发现癌前病变、早期癌,减少漏诊、误诊.     

VIA、VILI在农村宫颈癌筛查中的应用

目的 寻找适合农村地区子宫颈癌及其癌前病变的筛查方法,为降低子宫颈癌的发病率及病死率提供科学方法.方法 以湖北省五峰县（宫颈癌早诊早治项目县之一）长乐坪镇30-59岁的已婚妇女作为对象,进行以人群为基础的子宫颈癌筛查,对符合条件的妇女进行危险因素、癌症及子宫颈癌认知情况的问卷调查,5%醋酸染色后肉眼观察（VIA）和2%的卢戈氏碘染色后肉眼观察（VILI）结果异常者,进行阴道镜下活组织检查并得到最终的病理学诊断,将病变检出率与同年在五峰县其它乡镇的宫颈刮片细胞学筛查结果进行比较.结果 该次筛查人群参与率为70%,最终经活检病理确诊的CINⅠ患病率为0.5%（10例）,CINⅡ0.5%（11例）,CINⅢ1.0%（20例）,子宫颈癌0.1%（2例）;宫颈癌及其癌前病变有年轻化趋势;该次单纯由肉眼观察对CINⅠ、CINⅡ的病变检出率,与同年在当地其它乡镇宫颈刮片细胞学普查结果相当,差别无统计意义,但对≥CINⅢ的病变检出率高于宫颈刮片细胞学筛查结果,有统计学意义.结论 肉眼观察是一种经济有效的宫颈癌筛查方法,适宜在农村地区推广,能使更多贫困地区的妇女及时得到子宫颈癌的早诊早治.     

甲氨喋呤与甲氨喋呤联合米非司酮治疗异位妊娠100例疗效比较

目的评价甲氨喋呤联合米非司酮治疗异位妊娠的疗效.方法符合保守治疗宫外孕100例,随机分为对照组、治疗组,每组各50例.对照组甲氨喋呤肌肉注射100mg,一周后血β-HCG无下降趋势者,再注射1次;治疗组肌肉注射甲氨喋呤100mg,联合服用米非司酮50 mg/次,2次/d,共3 d.结果治疗组疗效明显高于对照组,两组比较有显著性差异(P＜0.05).结论甲氨喋呤联合米非司酮治疗异位妊娠大大提高疗效,特别对要求保留生育功能的年轻患者,不失为一种有效的治疗方法.     

LEEP环切电刀在宫颈上皮内瘤样病变诊断和治疗中的价值

目的 探讨LEEP环切电刀治疗宫颈上皮内瘤样病变的临床应用价值。方法 湖北五峰妇幼保健院对24例宫颈上皮内瘤样病变行阴道镜下点状活检和LEEP环切电刀术后病理诊断并对二者结果进行分析此较。结果 阴道镜下活检与LEEP刀术后标本的病理诊断有显著差异（P〈0．05）。结论 LEEP刀对宫颈上皮内瘤样病变是非常理想的诊断与治疗方法，有效阻断癌前病变发展为浸润癌。     

老年人Meigs综合征并糖类抗原125升高1例

Meigs综合征(Meigs’’ syndrome, MS)多见于围绝经期女性, 老年人少见, 有关诊断标准临床混淆严重, 极易误诊。现通过分享1例合并糖类抗原125(CA125)升高的老年人Meigs综合征的诊治过程, 以期更好地了解Meigs综合征, 减少临床漏诊、误诊。