Amiri, Fatemeh

Simorgh Research Repository

     داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ و ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﻲ و درﻣﺎﻧﻲ ﻛﺮﻣﺎن  داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ ﻣﻬﻨﺪس اﻓﻀﻠﻲ ﭘﻮر  ﻧﺎﻣﻪ: ﻳﺎنﭘﺎ  ﺟﻬﺖ درﻳﺎﻓﺖ درﺟﻪ دﻛﺘﺮاي ﺗﺨﺼﺼﻲ ﭘﺰﺷﻜﻲ  ﻋﻨﻮان: ﺷﺴﺘﺸﻮ از ﭘﺲ رﺣﻢ دﻫﺎﻧﻪ ﻣﺴﺘﻘﻴﻢ ﻣﺸﺎﻫﺪه روش دو ﻏﺮﺑﺎﻟﮕﺮي ارزش ﻣﻘﺎﻳﺴﻪ ﺳﺮوﻳﻜﺲ ﺳﺮﻃﺎﻧﻲ ﭘﻴﺶ ﺿﺎﻳﻌﺎت ﺗﺸﺨﻴﺺ در اﺳﻤﻴﺮ ﭘﺎپ و اﺳﺘﻴﻚ اﺳﻴﺪ ﺑﺎ اﺳﺘﺎد راﻫﻨﻤﺎ:  زﻫﺮا ﻫﻨﺮوردﻛﺘﺮ   ﭘﮋوﻫﺶ و ﻧﮕﺎرش:  ﻓﺎﻃﻤﻪ اﻣﻴﺮيدﻛﺘﺮ  79 ﺑﻬﺎر      ﭼﻜﻴﺪهي ﺷﺎﻳﻊ زﻧﺎن اﺳﺖ ﻛﻪ ﺗﺸﺨﻴﺺ زودﻫﻨﮕﺎم آن، اﻫﻤﻴﺖ زﻳﺎدي ﺟﻬﺖ ﻫﺎ ﺳﺮﻃﺎن ازﺟﻤﻠﻪ رﺣﻢ ي ﺳﺮﻃﺎن دﻫﺎﻧﻪ ﻣﻘﺪﻣﻪ: ﺪهﻛﻪ ﻣﺸﺎﻫ اﻧﺪ ﮔﺮﻓﺘﻪي ﺟﺎﻳﮕﺰﻳﻦ ﭘﺎپ اﺳﻤﻴﺮ در ﻣﻨﺎﻃﻖ ﻣﺨﺘﻠﻒ دﻧﻴﺎ ﻣﻮرد ارزﻳﺎﺑﻲ ﻗﺮار ﻫﺎ روشاﺛﺮﺑﺨﺸﻲ درﻣﺎن دارد. ارزش  ي ﺴﻪﻳﻣﻘﺎﺣﺎﺿﺮ ﺑﺎ ﻫﺪف  ي . ﺑﺪﻳﻦ ﻣﻨﻈﻮر ﻣﻄﺎﻟﻌﻪﻫﺎﺳﺖ روشاﻳﻦ  ي ازﺟﻤﻠﻪ  )AIV(ﺑﺎ اﺳﻴﺪ اﺳﺘﻴﻚ ﻣﺴﺘﻘﻴﻢ ي ﺺﻴدر ﺗﺸﺨ ﺮﻴو ﭘﺎپ اﺳﻤ ﻚﻴاﺳﺘ ﺪﻴرﺣﻢ ﭘﺲ از ﺷﺴﺘﺸﻮ ﺑﺎ اﺳ ي دﻫﺎﻧﻪ ﻢﻴﻣﺴﺘﻘ ي دو روش ﻣﺸﺎﻫﺪه يﻏﺮﺑﺎﻟﮕﺮ  اﻧﺠﺎم ﺷﺪ. ﻜﺲﻳﺳﺮو ﻲﺳﺮﻃﺎﻧ ﺶﻴﭘ ﻌﺎتﻳﺿﺎﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن اﻓﻀﻠﻲ  ﻛﻨﻨﺪه ﻣﺮاﺟﻌﻪزن  403 ﺷﺎﻣﻞ ،ﻣﻘﻄﻌﻲ-ﺗﻮﺻﻴﻔﻲ ي اﻳﻦ ﻣﻄﺎﻟﻌﻪآﻣﺎري ي ﺟﺎﻣﻌﻪ  :ﻫﺎ روشﻣﻮاد و ﭘﺲ از رﺿﺎﻳﺖ آﮔﺎﻫﺎﻧﻪ، ﺷﺪﻧﺪ.  ﺑﻪ ﺷﻴﻮه در دﺳﺘﺮس اﻧﺘﺨﺎبﺑﻮد ﻛﻪ ﻫﻤﮕﻲ  5931-6931ي ﻫﺎ ﺳﺎلﭘﻮر ﻛﺮﻣﺎن در و آزﻣﻮن آﻣﺎري  22ﻧﺴﺨﻪ  SSPS اﻓﺰار ﻧﺮمﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﻛﻮﻟﭙﻮﺳﻜﻮﭘﻲ اﻧﺠﺎم ﺷﺪ. دادهو AIVﺗﺴﺖ ﭘﺎپ اﺳﻤﻴﺮ،   ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﻞﻴﺤﻠو ﺗ ﻪﻳﺗﺠﺰاﺳﻜﻮﺋﺮ ﻣﻮرد ﻛﺎيﻧﻔﺮ  89( ﻣﺜﺒﺖ ﺑﻮد. 56/97ﻧﻔﺮ )% 002 AIV( و ﻧﺘﻴﺠﻪ ﺗﺴﺖ 44/47ﻧﻔﺮ )% 631ﻧﺘﻴﺠﻪ ﺗﺴﺖ ﭘﺎپ اﺳﻤﻴﺮ  ﻧﺘﺎﻳﺞ:% و 49/9، به ترتيب AIVﻧﺸﺎن داد ﺣﺴﺎﺳﻴﺖ و وﻳﮋﮔﻲ ﺗﺴﺖ  ﻫﺎ داده( ﻛﻮﻟﭙﻮﺳﻜﻮﭘﻲ ﻣﺜﺒﺖ داﺷﺘﻨﺪ. ﺗﺤﻠﻴﻞ 23/42)% ١NICﻣﻮارد  39/5ﺑﻮد. در % 06/91و % 55/1% ﺑﻪ ﺗﺮﺗﻴﺐ، ﺑﻮد. ﻫﻤﭽﻨﻴﻦ ﺣﺴﺎﺳﻴﺖ و وﻳﮋﮔﻲ ﺗﺴﺖ ﭘﺎپ اﺳﻤﻴﺮ 84/60% 05/0، %١NICﻣﻮارد  44/2در % ﻛﻪ ﻲدرﺣﺎﻟ( p=1/0ﻣﺜﺒﺖ ﺑﻮد ) AIV، ﻧﺘﻴﺠﻪ ﺗﺴﺖ 3NICو  ٢NICﻣﻮارد  001و %  (.p=0/329ﺑﻮد ) واﻗﻌﻲ ﻣﺜﺒﺖﭘﺎپ اﺳﻤﻴﺮ ، ﻧﺘﻴﺠﻪ ﺗﺴﺖ ٣NICﻣﻮارد  24/9و % ٢NICﻣﻮارد ﻣﻮارد  و ﺣﺎﻛﻲ از ﺷﻨﺎﺳﺎﻳﻲ ﻧﺰدﻳﻚ ﺑﻪ ﺗﻤﺎﻣﻲ آﻣﺪه ﺑﻪ دﺳﺖ %49/9 ﻣﻘﺪار ﺣﺴﺎﺳﻴﺖ AIVدر ﺗﺴﺖ  ي:ﺮﻴﮔ ﺠﻪﻴﻧﺘﻧﺴﺒﺖ ﺑﻪ ﭘﺎپ   AIVﺗﺴﺖ  .آﻣﺪﺑﻪ دﺳﺖ  % 84/60اﻣﺎ از ﻃﺮف دﻳﮕﺮ ﻣﻘﺪار وﻳﮋﮔﻲ ﺗﺴﺖ  ﺑﺎﺷﺪ ﻲﻣﺑﻴﻤﺎري ﺗﻮﺳﻂ ﺗﺴﺖ در  AIVﻧﺘﺎﻳﺞ ﺗﺴﺖ . دارد 3NIC ,2NIC ﺧﺼﻮص ﺑﻪ ﺳﺮﻃﺎﻧﻲاﺳﻤﻴﺮ ﻗﺪرت ﺗﺸﺨﻴﺺ ﺑﺴﻴﺎر ﺑﺎﻻﺗﺮي در ﺿﺎﻳﻌﺎت ﭘﻴﺶ   ﺑﺎﻻﺗﺮي ﺑﻬﺒﻮد داده اﺳﺖ. اﻧﺪازه ﺑﻪﺳﺮوﻳﻜﺲ ارزش ﺗﺸﺨﻴﺼﻲ را  ﺳﺮﻃﺎﻧﻲ ﭘﻴﺶ ﺗﺸﺨﻴﺺ ﺿﺎﻳﻌﺎت  رﺣﻢ، ﭘﺎپ اﺳﻤﻴﺮ، ﻛﻮﻟﭙﻮﺳﻜﻮﭘﻲ ي دﻫﺎﻧﻪﺳﺮﻃﺎن  ﻛﻠﻤﺎت ﻛﻠﻴﺪي:  ﻲﺴﻴﻠﮕﻧا ﻪﺻﻼﺧ  Abstract Background and objectives: Cervical cancer is one of the most common cancers in women. Early diagnosis of precancerous cervical lesions is of great importance for the effective treatment of this disease. Visual Inspection with Acetic acid (VIA) is one of several methods that can serve as an alternative to the Pap test for such diagnosis. This study aimed to compare the screening value of VIA and Pap test in the diagnosis of precancerous lesions in the cervix. Materials and Methods: The populations of this descriptive cross-sectional study consist of ٣٠٤ women referred to Afzalipour hospital in Kerman, Iran from March ٢٠١٦ to March ٢٠١٧. The sample was formed by the convenience sampling method. After obtaining informed consent, Pap test and VIA were performed and followed by colposcopy. Data were analyzed by SPSS version ٢٢ using the Chi-square test. Findings: The result of Pap test in ١٣٦ (٤٤٫٧٤٪) and VIA in ٢٠٠ (٦٥٫٧٩٪) patients was positive. In total, the result of colposcopy in ٩٨ patients (٣٢٫٢٤٪) was positive. Data analysis showed that the sensitivity and specificity of VIA was ٩٤٫٩% and ٤٨٫٠٦% respectively. The sensitivity and specificity of Pap test were found to be ٥٥.١٠٪ and ٦٠٫١٩% respectively. In ٩٣٫٥٪ of CIN١ cases and ١٠٠٪ of CIN٢ and CIN٣ cases, VIA results were true positive (p = ١٫٠), whereas in ٤٤٫٢٪ of CIN١ cases, ٥٠٪ of CIN٢ cases, and ٤٢٫٩٪ of CIN٣ cases, Pap test results were true positive (p = ٠٫٩٢٣). Conclusion: The sensitivity of VIA was ٩٤٫٩%, which reflected its ability to identify almost all the cases of the disorder, but its specificity was found to be only ٤٨.٠٦%, which means it have higher diagnostic power rather than pap test in precancerous cervical lesions specified CIN١ and CIN٢. VIA was found to be significantly more effective than Pap test in improving the diagnosis of precancerous cervical lesions. Keywords: Cervical cancer, Pap test, Colposcopy   Balatarin  Kerman University of medical sciences Afzalipour medical college Thesis for Specialist Physician Title: Comparison between Pap test and visual inspection with acetic acid in diagnosis of preinvasive cervical lesions Under guidance Dr Zahra Honarvar  By: Dr Fatemeh Amiri Spring ٢٠١٨   

مقایسه ارزش غربالگری دو روش مشاهده مستقیم دهانه رحم پس از شستشو با اسید استیک و پاپ اسمیر در تشخیص ضایعات پیش سرطانی سرویکس

http://eprints.kmu.ac.ir/29277/1/6828.pdf

مقایسه ارزش غربالگری دو روش مشاهده مستقیم دهانه رحم پس از شستشو با اسید استیک و پاپ اسمیر در تشخیص ضایعات پیش سرطانی سرویکس

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