阴道镜检查在宫颈疾病诊断中的应用

目的:探讨阴道镜检查在宫颈病变诊断中的应用价值。方法:对我院2010年7月至2010年10月150例患者进行阴道镜检查,对镜下可疑宫颈病变110例患者病变处取活检送病理检查,将结果行分析总结。结果:110例宫颈病变中,阴道镜检查诊断慢性宫颈炎83例,不典型增生21例,宫颈癌6例;病理诊断慢性宫颈炎77例,不典型增生25例,宫颈癌8例。阴道镜下诊断与病理诊断符合率最高可达92.77%。结论:阴道镜检查联合病理活检能及时发现宫颈癌前病变和宫颈癌,提高宫颈癌及癌前病变的早期检出率。     

阴道镜配合病理活检应用于宫颈疾病的诊断价值

目的评价电子阴道镜及宫颈病理活检对宫颈疾病的诊断价值。方法收集我院妇科门诊2003年至2006年宫颈疾病患者行阴道镜检查病行宫颈活检的病理结果进行对照分析。结果电子阴道镜检查后行宫颈活检1060例,病理结果显示:宫颈癌16例,宫颈上皮内瘤样变342例,宫颈炎性病变702例,阴道镜诊断宫颈上皮内瘤样变及宫颈癌的符合率分别为:93.44%和93.75%。结论阴道镜检查配合病理活检诊断宫颈疾病结果及时可靠,尤其对宫颈上皮内瘤样变的早诊断及降低宫颈癌的发生率有重要价值。     

妇科临床病例人乳头瘤病毒检测结果分析

目的 观察妇科临床病例人乳头状瘤病毒(HPV)感染现状,为预防宫颈癌提供参考.方法 以有性生活史的妇科病例作为检测对象;由妇产科医生采样,以反向杂交膜技术基因芯片进行HPV DNA检测;采用x2检验和趋势分析(Z)作检出率显著性检验.结果 共检测病例4347例,HPV检出率为24.64％;检出亚型23种,检出率以16型(8.10％)居高(X2＞6.63,P＜0.01),其次为43(3.93％)、58(3.52％)和52型(3.31％),显著高于其他19种亚型(x2＞6.63,P＜0.01),＞1％＜3％的有6、11、18、33、56型,其余14个亚型＜1％;随着年龄增长检出率呈上升趋势(Z=3.32,P＜0.01);阴道分泌物增多、不明原因阴道出血、月经紊乱等4类症状检出率为20.68％～25.59％,阴道分泌物增多加不明原因出血病例检出率为30.76％,宫颈鳞状上皮癌80例均检出HPV,高危型占97.50％ (78/80),16型占70.00％ (56/80),仅为低危型感染占2.50％(11型,2/80);炎性疾病检出率为24.75％,宫颈炎、阴道炎、宫颈炎合并症检出率为23.03％ ～ 28.38％,外阴炎为16.81％.结论 妇科临床病例HPV检出率以16型居首,其次为43、58和52型;宫颈癌检出率100％,阴道分泌物增多加阴道不明原因出血和宫颈炎为主的病例检出率较高;年龄越大,检出率越高,显示高年龄宫颈炎性疾病或阴道分泌物增多加不明原因阴道出血病例,是HPV和宫颈鳞状上皮癌防治的首要对象.     

FRD上皮组织特殊染色液筛查宫颈病变的应用研究

为了研究FRD上皮组织特殊染色液筛查宫颈病变的应用,本研究选取2014年1月到2015年8月于我院和中山大学附属第一医院就诊的妇科患者,FRD染色检查宫颈病变,共500例为研究对象。所有患者进行FRD染色,同时进行TCT及HPV DNA检测。进一步行阴道镜检查的指证为三者任意一项异常,若患者宫颈外口异常,则于该处组织活检,活检过程中严格根据阴道镜结果。结果表明本组500例患者中,FRD检测结果阳性324例,阴性176例;阴道镜检测结果表明,阳性宫颈炎症111例,CINⅠ159例,CINⅡ45例,CINⅢ9例;FRD与阴道镜病理检测结果符合率为78.34%。TCT检测结果 NILM 184例,ASCUS 170例,ASCUS-H 77例,LSIL50例,HSIL 19例;TCT检测与阴道镜病理检测结果符合率为54.89%。HPV检测结果阳性258例,阴性242例;阴道镜检测结果表明,阳性宫颈炎症111例,CINⅠ159例,CINⅡ45例,CINⅢ9例;FRD与阴道镜病理检测结果符合率为62.30%。病变诊断中,HPVTCTFRD,FRD阳性检测率显著高于HPV及TCT阳性检测率,差异具有统计学意义(p0.05)。从这里我们可以看出,在早期宫颈病变检测中,FRD检测、TCT检测及HPV检测均有一定的诊断价值,且在特异性、敏感性以及阳性预测值方面,和其他两种检测方法相比,FRD较优,值得临床推广应用。     

液基细胞、HPV检测与阴道镜宫颈癌的筛查方面的应用研究

目的:探讨液基薄层细胞学检查、HPV-DNA检测、阴道镜检查在宫颈癌早期诊断中的临床应用价值.方法:回顾性分析92例宫颈液基薄层细胞学检查未能明确诊断意义的宫颈非典型鳞状细胞病变患者,进行HPV-DNA检测与阴道镜检查,将检测的结果进行对比研究.结果:阴道镜与宫颈液基薄层细胞检查(TCT)及HPV检测在宫颈上皮内瘤变的灵敏度相比,差异有统计学意义(P＜0.05),阴道镜的检出率最高.随着TCT结果的病变级别提高,HPV感染率也提高,ASCUS组与LSIL组之间差异有统计学意义(P＜0.05).ASCUS、LSIL、HSIL病理活检的阳性率差异明显(P＜0.05),有统计学意义.宫颈的不同病变年龄主要集中在31-50岁之间.结论:宫颈液基薄层细胞学检查异常的患者,应进行HPV检测及阴道镜下活检,三步筛查法可大幅度提高宫颈高度病变的检出率,并且30-50岁的女性应定期做宫颈细胞学检查、HPV检测及阴道镜检查.     

阴道镜直视宫颈多点活检与传统宫颈活检在宫颈疾病诊断中的应用价值比较

目的:探讨阴道镜直视宫颈多点活检与传统宫颈活检对宫颈疾病诊断的临床应用及影响因素研究。方法:选择2015年5月至2016年3月我院妇科收治的宫颈疾病患者86例,按照随机数表法,将患者分为对照组和研究组,每组43例。对照组患者进行常规的宫颈活检,研究组患者采用阴道镜直视宫颈多点活检。对比两种检查方法与病理检查结果的检出率,并比较两种检查方法的漏诊率,另外考察影响阴道镜直视宫颈多点活检漏诊率的相关因素。结果:与病理检查结果相比,除宫颈炎和宫颈癌外,研究组对其他类型宫颈疾病的检出率及总检出率明显高于对照组(P0.05);除宫颈癌外,研究组对各种宫颈疾病的漏诊率与对照组相比明显下降(P0.05);年龄超过50岁,高级别的CIN类型、标本个数的减少及宫颈微小病变都可能升高阴道镜直视宫颈多点活检漏诊率。结论:与传统宫颈活检相比,阴道镜直视宫颈多点活检对宫颈疾病的诊断具有较高的诊断率,并且漏诊率较低,可以适当增加活检的样本个数来降低漏诊率,从而尽早发现并进行有效治疗,值得在临床上推广应用。     

阴道微生态亚失调状态的研究

目的 :提出阴道微生态亚失调状态的概念及其特征与机制。方法 :选取门诊及妇女健康普查患者 2 0 9例。健康妇女 10 2例为对照组 ;以临床主治外阴不适或偶有瘙痒 ,阴道分泌物增多 ,分泌物检查排除特异性微生物感染及细菌性阴道炎、严重宫颈炎的患者 10 7例为观察组 ;取阴道分泌物经倍比稀释接种于各培养基上进行需氧及厌氧培养 ,鉴定并检测微生物种类 ,活菌计数 ,检测菌种为乳酸杆菌、白色念珠菌、类杆菌、大肠埃希菌、链球菌 ,并同时测定阴道 p H值及清洁度。结果 :p H值无显著变化 (P>0 .0 5 ) ,清洁度观察组变化明显 ( °～ °) ;各菌种活菌计数观察组与对照组相比变化显著 (P>0 .0 5 )。结论 :阴道微生境在内外因素作用下存在一种过渡状态 ,该状态呈可逆性 ,在机体抵抗力增加或 /和去掉诱因后可自然恢复 ,如进一步发展可导致特异性或非特异性阴道炎、宫颈炎。作者由此提出“阴道微生态亚失调状态”概念。     

妊娠早期出血处理措施研究

目的:探讨分析妊娠早期出血的原因及其处理措施。方法:选取我院2009年~2012年接收的妊娠早期出血患者56例作为观察组,选取同一时间正常妊娠孕妇56例作为对照组,比较两组的检查情况。结果:妇科检查结果,妊娠早期出血的主要原因为先兆性流产,而宫颈糜烂、宫颈息肉、阴道炎等也可以造成妊娠早期出血;B超或彩超检查结果,38例先兆性流产,5例胚胎停止发育,NT测定成功7例,宫腔内有积血现象。结论:妊娠早期出血的原因主要是先兆性流产,也有部分是因宫颈或者阴道病变而导致的,所以一旦发生妊娠早期出血,必须进行具体全面的检查,防止影响母儿的健康。     

652例女性生殖道分泌物实验室检查结果分析

女性阴道宫颈炎是性传播疾病的主要疾病之一,临床上确切依据主要来自实验室对分泌物病原学检查,病原菌的不同,引起的疾病不同。我们对652例阴道分泌物多、臭、带色和呈奶酪状的门诊就诊患者进行了检测,现报道如下:1材料和方法1.1临床资料652例患者均为我院就诊女性,取其阴道后穹隆、宫颈分泌物。患者有不同程度的外阴瘙痒、红肿、白带增多、分泌物有异味等症状。病程最短1月,最长3年。患者年龄最小2岁,最大72岁,平均年龄32.4岁。1.2标本采集用无菌干棉签将宫颈口周围过多的黏液清除,再用无菌棉签放入阴道后穹隆及宫颈口1~2cm,轻轻旋转停留约…     

阴道微生态改变与人乳头瘤病毒感染和宫颈病变相关研究

目的 探讨阴道微生态变化对人乳头瘤病毒(Human papillomavirus,HPV)感染和宫颈病变的影响.方法 收集我院2018年11月至2019年7月门诊患者1 529例,进行阴道微生态和宫颈HPV检测,根据筛查结果阴道镜下多点活检,应用卡方检验分析阴道微生态变化在HPV阴性组和阳性组之间差异以及对宫颈病变程度...     

生物蛋白胶封堵合并宫颈环扎术治疗胎膜早破的疗效观察

目的:观察生物蛋白胶封堵合并宫颈环扎术治疗胎膜早破,对孕妇、胎儿及新生儿的影响,明确该技术治疗胎膜早破的疗效。方法:我院产科共收治妊娠<30周胎膜早破患者48例,采用生物蛋白胶封堵合并宫颈环扎术治疗胎膜早破,观察治疗后孕妇羊水指数,胎儿双顶径,新生儿出生时体重,及孕妇的副反应。结果:在本次封堵治疗过程中均一次封堵成功,没有不良反应发生,所有孕妇术后阴道流水情况均明显改善,其中有2例孕妇术后1周阴道流水停止。所有孕妇术后羊水漏出量均明显减少,B超检查显示羊水指数均在(6±2)cm,胎儿每周双顶径增长均达到(0.15±0.02)cm,延长孕周最短(5±2)w,10例早产,38例继续妊娠至37 w。新生儿出生时体重为(2000±260)g,无1例发生NRDS。同期没有进行宫颈内封堵仅行药物保胎治疗的10例孕妇,胎龄延长最长达到10 d,最短者24 h内出现早产分娩,早产儿平均体重1400 g,均发生NRDS,有2例放弃治疗,4例在NICU行治疗,最终因各种并发症死亡。48例行封堵治疗孕妇未发生过敏反应,无阴道出血及产后出血和感染等。结论:应用生物蛋白胶结合宫颈环扎术治疗胎膜早破,手术操作简单,可延长了孕周,提高了新生儿成活率,无不良反应,具有广泛的应用前景。     

先兆早产、胎膜早破、妊娠期糖尿病及正常妊娠女性阴道菌群分布的比较

目的:比较先兆早产、胎膜早破、妊娠期糖尿病及正常妊娠女性阴道菌群分布情况。方法:选择2016年6月至2018年6月在苏州大学附属第二医院妇产科住院的妊娠女性806例,其中先兆早产组206例,胎膜早破组234例,妊娠期糖尿病组156例,正常妊娠组210例。记录四组女性异常阴道菌群检出率及异常阴道菌群分布情况。结果:四组女性的年龄、孕周比较无统计学差异(P>0.05)。先兆早产组、胎膜早破组异常阴道菌群检出率高于妊娠期糖尿病组、正常妊娠组(P<0.05),而妊娠期糖尿病组、正常妊娠组异常阴道菌群检出率比较无统计学差异(P>0.05)。先兆早产组、妊娠期糖尿病组白色假丝酵母菌检出率高于胎膜早破组、正常妊娠组(P<0.05),先兆早产组、胎膜早破组阴道加德纳菌检出率高于妊娠期糖尿病组、正常妊娠组(P<0.05),先兆早产组无乳链球菌检出率高于胎膜早破组、妊娠期糖尿病组、正常妊娠组(P<0.05),胎膜早破组大肠埃希菌检出率高于先兆早产组、妊娠期糖尿病组、正常妊娠组(P<0.05)。结论:妊娠女性阴道感染以白色假丝酵母菌、大肠埃希菌、无乳链球菌、阴道加德纳菌为主,且先兆早产、胎膜早破女性阴道致病菌感染率较高,妊娠期糖尿病女性阴道白色假丝酵母菌的感染率较高。     

Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

Objective

To evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes.

Methods

A literature review was performed with the search terms, including intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid, covering the period from January, 1981 to January, 2014. We just focused on the pregnancy outcomes associated with different symptoms of an IUH.

Results

It is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy. However, the prognosis value of both volume and gestational age at diagnosis of IUH still remains controversial. Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted. It is believed by some that the earlier an IUH was detected, the higher the risk for adverse outcomes would be, while no or weak association were reported by other studies. The prognostic value of the simultaneous presence of vaginal bleeding on pregnancy outcome is also controversial.

Conclusions

Both the position relative to the placenta or uterus and duration of IUH have strong predictive value on the prognosis in the ongoing pregnancy. However, the prognostic values of the IUH volume, gestational age at diagnosis and the simultaneous presence of vaginal bleeding remain controversial up to now. Moreover, most of previous reports are small, uncontrolled studies with incomplete information. Prospective, large sample, cohorts studies which take all detailed symptoms of an IUH into consideration are needed when we evaluate its clinical significance in the prognosis of pregnancy.     

Postmenopausal bleeding of nonmalignant origin

A study was made of the medical records of 102 patients hospitalized because of postmenopausal bleeding. Diagnostic procedures used included vaginal examination, Papanicolaou smears, curettage and cervical biopsy. The major associated pathological conditions (possibly etiological factors) in the series were chronic cervicitis, fibromyoma of the uterus, endometrial polyps, cervical polyps and adenomyosis of the uterus. Sclerosis of the uterine vessels was suggested as another possible cause of this type of bleeding. Neither the amount and type of bleeding nor the pattern of associated symptoms were of diagnostic value.A history of hormonal therapy prior to the onset of bleeding is not sufficient evidence to establish that as the cause of the bleeding and the patient should be as completely investigated as if this history were not present. In over 61 per cent of cases in this series, uterine curettage with or without cervical biopsy, cauterization, conization or trachelorrhaphy, was the only treatment required for both diagnosis and therapy.     

宫颈不同疾病患者合并HPV感染的病原菌感染状况及免疫功能

目的 调查分析宫颈不同疾病患者合并人乳头瘤病毒（HPV）感染的病原菌感染状况及免疫功能。方法 选择2015年3月至2018年1月在我院就诊的96例宫颈不同疾病患者为研究组,其中宫颈炎组18例,宫颈上皮内瘤变组54例（CINⅠ组15例,CINⅡ组17例,CINⅢ组22例）,宫颈癌组24例;并以同期在我院进行体检的80例健康女性为对照组,检测所有研究对象的HPV感染、阴道菌群情况和宫颈分泌物CD4+、CD8+细胞数。结果 研究组HPV感染率明显高于对照组（P0.05）。宫颈炎组、CINⅠ组、CINⅡ组、CINⅢ组、宫颈癌组CD4+ T细胞表达阳性率呈下降趋势,宫颈癌组与宫颈炎组、CINⅠ组比较差异有统计学意义（P0.05）;CD4+/CD8+<1患者所占比例呈上升趋势,宫颈癌组、CINⅢ组、CINⅡ组与宫颈炎组比较差异有统计学意义（P<0.05）。结论 HPV感染、病原菌感染及免疫功能下降与宫颈病变发生发展密切相关,临床中应给予足够重视并及时进行有效干预。     

影响剖宫产术后并发产褥感染的相关危险因素分析

目的:探讨剖宫产术后产褥感染的相关危险因素,为临床制定感控措施提供参考。方法:回顾性分析我院接受剖宫产术的1760例孕妇的临床资料,采用单因素卡方检验及多因素Logistic回归方法对剖宫产术后发生产褥感染的相关危险因素进行统计学分析。结果:1760例接受剖宫产手术的孕妇,术后发生产褥感染的有68例,发生率为3.86%;发生产褥感染最常见的部位是急性子宫内膜炎、子宫肌炎,其构成比占57.4%;经过单因素卡方检验及多因素Logistic回归分析,最终筛选出手术时间(OR=1.351)、血红蛋白(OR=1.759)、胎膜早破(OR=2.247)、孕期生殖道感染反复发作(OR=2.047)、妊娠糖尿病(OR=1.473)、前置胎盘反复阴道出血(OR=1.584)与宫产术后发生产褥感染呈正相关(P0.05)。结论:手术时间、血红蛋白、胎膜早破、孕期生殖道感染反复发作、妊娠糖尿病、前置胎盘反复阴道出血是剖宫产后发生产褥感染的高危因素,临床应针对这些高危因素制定干预措施以降低感染的发生率。     

乳酸菌阴道胶囊在宫颈糜烂患者宫颈环形电切术后的应用

目的探讨乳酸菌阴道胶囊在宫颈糜烂患者宫颈环形电切（LEEP）术后的应用。方法选取宫颈糜烂患者76例,随机分为观察组（n=38例）和对照组（n=38例）。两组患者均在月经干净后3-7 d行LEEP术,观察组患者加用乳酸菌阴道胶囊阴道放置,每晚1粒,连用14 d。观察两组患者术后阴道流血量、出血持续时间及创面愈合时间,术后8周复诊评估其临床疗效。结果观察组患者术后的阴道流血量、出血持续时间及创面愈合时间明显少于对照组（χ2=7.54、5.65和8.49,P〈0.05或P〈0.01）;术后8周复诊,观察组的临床总有效率明显优于对照组（94.74%vs.78.95%,χ2=4.15,P〈0.05）。结论乳酸菌阴道胶囊在宫颈糜烂患者宫颈环形电切术后的应用具有明确的效果,能明显减少阴道出血量和出血持续时间,有利于促进创面愈合。     

乳酸依沙吖啶联合子宫颈扩张单球囊对瘢痕子宫中期妊娠引产的应用效果

目的:研究乳酸依沙吖啶联合子宫颈扩张单球囊对瘢痕子宫中期妊娠引产的应用效果。方法:选择2014年4月~2016年12月在我院进行诊治的由于社会因素或者医学因素自愿要求终止妊娠并无任何引产禁忌证的110例健康中期妊娠(孕周14~27周)孕妇为研究对象,随机分为观察组与对照组,每组各55例。对照组采用常规方案进行引产,即口服米非司酮150 mg,并在B超引导下经腹壁行羊膜腔内注射100 mg乳酸依沙吖啶;观察组采用乳酸依沙吖啶联合子宫颈扩张单球囊进行引产。比较两组孕妇的引产成功率、产程时间、宫缩发动时间、胎儿娩出时间、产后2 h出血量、住院时间、引产并发症的发生情况以及多次剖宫产患者的引产成功率。结果:观察组孕妇的引产成功率为96.36%(53/55),明显高于对照组[83.64%(46/55)](P0.05),且观察组的产程时间、宫缩发动时间、产后2 h出血量以及住院时间均明显低于对照组(P0.05)。对照组多次剖宫产孕妇引产成功率为33.33%(2/6),观察组多次剖宫产孕妇引产成功率为100.00%(7/7),观察组明显高于对照组(P0.05)。对照组发生宫颈裂伤1例,会阴裂伤1例,两组孕妇均未出现羊水栓塞、子宫破裂以及感染等并发症。结论:乳酸依沙吖啶联合子宫颈扩张单球囊用于瘢痕子宫中期妊娠引产的应用效果明显优于口服米非司酮并在B超引导下经腹壁行羊膜腔内注射乳酸依沙吖啶,且安全性高。     

The development of cervical and vaginal adenosis as a result of diethylstilbestrol exposure in utero

Exposure to exogenous hormones during development can result in permanent health problems. In utero exposure to diethylstilbestrol (DES) is probably the most well documented case in human history. DES, an orally active synthetic estrogen, was believed to prevent adverse pregnancy outcome and thus was routinely given to selected pregnant women from the 1940s to the 1960s. It has been estimated that 5 million pregnant women worldwide were prescribed DES during this period. In the early 1970s, vaginal clear cell adenocarcinomas (CCACs) were diagnosed in daughters whose mother took DES during pregnancy (known as DES daughters). Follow-up studies demonstrated that exposure to DES in utero causes a spectrum of congenital anomalies in female reproductive tracts and CCACs. Among those, cervical and vaginal adenoses are most commonly found, which are believed to be the precursors of CCACs. Transformation related protein 63 (TRP63/p63) marks the cell fate decision of Müllerian duct epithelium (MDE) to become squamous epithelium in the cervix and vagina. DES disrupts the TRP63 expression in mice and induces adenosis lesions in the cervix and vagina. This review describes mouse models that can be used to study the development of DES-induced anomalies, focusing on cervical and vaginal adenoses, and discusses their molecular pathogenesis.     

Cervical cytology of recurrent psammoma bodies with atypical cells in a postmenopausal woman: a case report

BACKGROUND: Psammoma bodies (PBs) are an unusual finding in cervical cytology preparations. They have been identified in association with a wide range of benign and malignant conditions within the female genital tract. Portents of a significant underlying pathology include their occurrence in postmenopausal patients, the presence of unexplained vaginal bleeding and their occurrence in association with atypical cells. CASE: PBs associated with atypical cells were detected in repeated cervical cytology smears of an asymptomatic, 55-year-old postmenopausal woman over a 4-year period. She was extensively investigated, and, in the absence of a bleeding) have definitive cause, she underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histologic examination of the specimen demonstrated the presence of bilateral benign ovarian serous cystadenofibromas with large numbers of PBs. Focally the PBs were closely apposed to the serosal surface and invested in a blanket of mesothelial cells. CONCLUSION: Caution is required when assessing the significance of PBs associated with atypical cells in a cervical cytology specimen. Our case demonstrates the presence of ovarian mesothelial cells mimicking atypical glandular cells.