Pedram, Pardis

Simorgh Research Repository

      داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻛﺮﻣﺎن  داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ  ﭘﺎﻳﺎن ﻧﺎﻣﻪ دوره ﭘﺰﺷﻜﻲ ﻋﻤﻮﻣﻲ   ﻋﻨﻮان:ﺑﺮرﺳﻲ ﺷﻴﻮع ﺿﺎﻳﻌﺎت ﭘﺮه اﻳﻨﻮﻳﺰﻳﻮ)ﭘﻴﺶ ﺳﺮﻃﺎﻧﻲ( ﺳﺮوﻳﻜﺲ در ﺑﻴﻤﺎران ﻣﺮاﺟﻌﻪ ﻛﻨﻨﺪه ﺑﺎ ﭘﺎپ اﺳﻤﻴﺮ ﻟﻐﺎﻳﺖ ﭘﺎﻳﺎن ﺳﺎل  5931از اﺑﺘﺪاي ﺳﺎل  ﻏﻴﺮﻃﺒﻴﻌﻲ ﺑﻪ درﻣﺎﻧﮕﺎه ژﻧﻴﻜﻮاﻧﻜﻮﻟﻮژي ﺑﻴﻤﺎرﺳﺘﺎن اﻓﻀﻠﻲ ﭘﻮر  6931  ﺗﻮﺳﻂ:  ﭘﺮدﻳﺲ ﭘﺪرام  اﺳﺘﺎد راﻫﻨﻤﺎ:  ﻫﻨﺮور ﺳﺮﻛﺎر ﺧﺎﻧﻢ دﻛﺘﺮ  ﺳﺎل ﺗﺤﺼﻴﻠﻲ:  69-79     اﻳﻦ ﭘﮋوﻫﺶ ﺑﺎ ﻫﺪف ﺑﺮرﺳﻲ ﺷﻴﻮع ﺿﺎﻳﻌﺎت ﭘﺮه اﻳﻨﻮﻳﻮ )ﭘﻴﺶ ﺳﺮﻃﺎﻧﻲ( ﺳﺮوﻳﻜﺲ در ﺑﻴﻤﺎران  زﻣﻴﻨﻪ و ﻫﺪف:  ﻣﺮاﺟﻌﻪ ﻛﻨﻨﺪه ﺑﺎ ﭘﺎپ اﺳﻤﻴﺮ ﻏﻴﺮﻃﺒﻴﻌﻲ در ﻣﺎﻧﮕﺎه ژﻧﻴﻜﻮاﻧﻜﻮﻟﻮژي ﺑﻴﻤﺎرﺳﺘﺎن اﻓﻀﻠﻲ ﭘﻮرﻛﺮﻣﺎن اﻧﺠﺎم ﮔﺮدﻳﺪ.ﺑﻴﻤﺎران ﻣﺮاﺟﻌﻪ ﻧﻔﺮ از  632ﺗﺤﻠﻴﻠﻲ  ﺑﻮد ﻛﻪ ﺑﺮ روي  -اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﻲ از ﻧﻮع ﺗﻮﺻﻴﻔﻲ  ﻣﻮاد و روش ﻫﺎ:ﻧﻔﺮ  002ﻧﻔﺮ داراي ﭘﺎپ اﺳﻤﻴﺮ ﻃﺒﻴﻌﻲ و  63ﻛﻪ در ﻣﺎﻧﮕﺎه ژﻧﻴﻜﻮاﻧﻜﻮﻟﻮژي ﺑﻴﻤﺎرﺳﺘﺎن اﻓﻀﻠﻲ ﭘﻮرﻛﺮﻣﺎن  ﻪﻛﻨﻨﺪه ﺑﺗﻤﺎﻣﻲ ﺑﻴﻤﺎران ﺗﻮﺳﻂ ژﻧﻴﻜﻮاﻧﻜﻮﻟﻮژﻳﺴﺖ ﺗﺤﺖ ﻛﻮﻟﭙﻮﺳﻜﻮﭘﻲ ﻗﺮار اﻧﺠﺎم ﺷﺪ. داراي ﭘﺎپ اﺳﻤﻴﺮ ﻏﻴﺮﻃﺒﻴﻌﻲ ﺑﻮدﻧﺪ، از آن ﻫﺎ ﺑﻴﻮﭘﺴﻲ ﮔﺮﻓﺘﻪ ﺷﺪ. در ﺻﻮرت ﻋﺪم ﻣﺸﺎﻫﺪه  ﮔﺮﻓﺘﻨﺪ و در ﺻﻮرت وﺟﻮد ﺿﺎﻳﻌﺎت ﻣﺸﻜﻮك در ﺳﺮوﻳﻜﺲﺳﺮوﻳﻜﺲ و ﻫﻢ ﺳﻴﺘﻮﻟﻮژي اﻧﺪوﺳﺮوﻳﻜﺲ ﮔﺮﻓﺘﻪ ﺷﺪ.  21و  9و  6و 3ﺑﻴﻮﭘﺴﻲ ﺗﺼﺎدﻓﻲ از ﺳﺎﻋﺖ ﻫﺎي  4ﺿﺎﻳﻌﻪ ﻫﻢ اﻧﻮاع ﺿﺎﻳﻌﺎت  ﺷﻴﻮعﺳﭙﺲ ﻧﻤﻮﻧﻪ ﻫﺎي ﭘﺎﺗﻮﻟﻮژي ﺑﻴﻤﺎران ﺗﻮﺳﻂ اﺳﺎﺗﻴﺪ ﭘﺎﺗﻮﻟﻮژي ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ ﺗﺎ ﻣﻴﺰان ﻜﺲ در اﻧﻮاع ﭘﺎپ اﺳﻤﻴﺮ ﻏﻴﺮﻃﺒﻴﻌﻲ ﺑﺮ ﺣﺴﺐ ﻧﻮع ﭘﺎپ اﺳﻤﻴﺮ و ﻫﻢ ﭼﻨﻴﻦ ﻧﻮع ﭘﺎپ اﺳﻤﻴﺮ ﭘﻴﺶ ﺳﺮﻃﺎﻧﻲ ﺳﺮوﻳ  ﮔﺮدﻳﺪﻧﺪ. ﺗﺤﻠﻴﻞ ssps22آﻣﺎري ﻧﺮم اﻓﺰار از اﺳﺘﻔﺎده ﺑﺎ ﻫﺎ داده ﻏﻴﺮﻃﺒﻴﻌﻲ ﻣﺸﺨﺺ ﺷﻮد.درﺻﺪ ﻣﻲ ﺑﺎﺷﺪ. اﺧﺘﺼﺎﺻﻴﺖ ﭘﺎپ  % 69/4ﺣﺴﺎﺳﻴﺖ ﭘﺎپ اﺳﻤﻴﺮ ﺑﺮاي ﺗﺸﺨﻴﺺ ﺿﺎﻳﻌﺎت ﭘﻴﺶ ﺳﺮﻃﺎﻧﻲ ﻳﺎﻓﺘﻪ ﻫﺎ: % و وارزش اﺧﺒﺎري ﻣﻨﻔﻲ  14ﻣﻲ ﺑﺎﺷﺪ. ﻫﻢ ﭼﻨﻴﻦ ارزش اﺧﺒﺎري ﻣﺜﺒﺖ ﺑﺮاي ﭘﺎپ اﺳﻤﻴﺮ ﺑﺮاﺑﺮ  % 12/8اﺳﻤﻴﺮ درﺻﺪ ﻣﻲ  % 89/8% ﺑﻮد. ﺣﺴﺎﺳﻴﺖ ﻛﻮﻟﭙﻮﺳﻜﻮﭘﻲ ﺑﺮاي ﺗﺸﺨﻴﺺ ﺿﺎﻳﻌﺎت ﭘﻴﺶ ﺳﺮﻃﺎﻧﻲ  19/6ﺑﺮاي آن ﺑﺮاﺑﺮ ﺑﻮد ﻛﻪ ﻧﻔﺮ  611ﻧﻔﺮ و ﺗﻌﺪاد ﻣﺜﺒﺖ ﻛﺎذب ﺑﺮاي آن  53ﺑﺎﺷﺪ. ﻫﻤﭽﻨﻴﻦ ﺗﻌﺪاد ﻣﻨﻔﻲ ﺣﻘﻴﻘﻲ ﺑﺮاي ﻛﻮﻟﭙﻮﺳﻜﻮﭘﻲ % و وارزش  24% ﺑﻮد. ﻫﻢ ﭼﻨﻴﻦ ارزش اﺧﺒﺎري ﻣﺜﺒﺖ ﺑﺮاي ﻛﻮﻟﭙﻮﺳﻜﻮﭘﻲ ﺑﺮاﺑﺮ  32/1اﺧﺘﺼﺎﺻﻴﺖ ﻛﻮﻟﭙﻮﺳﻜﻮﭘﻲ   % ﺑﻮد. 79/2اﺧﺒﺎري ﻣﻨﻔﻲ ﺑﺮاي آن ﺑﺮاﺑﺮ  ﻪﺠﻴﺘﻧ :يﺮﻴﮔ ياﺮﺑ ﻲﻳﻻﺎﺑ ﻲﺼﻴﺨﺸﺗ شزرا ﻲﻳﺎﻬﻨﺗ ﻪﺑ ﺰﻛﺮﻣ ﻦﻳا رد ﻲﭘﻮﻜﺳﻮﭙﻟﻮﻛ ،ﻪﻌﻟﺎﻄﻣ ﺞﻳﺎﺘﻧ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﺷاﺪﻧ ﺲﻜﻳوﺮﺳ تﺎﻌﻳﺎﺿ ﺺﻴﺨﺸﺗ ياﺮﺑ ﻲﻜﻤﻛ ﺖﺴﺗ ناﻮﻨﻋ ﻪﺑ و ﻲﺴﭘﻮﻴﺑ و يژﻮﻟﻮﺘﻴﺳ ﺎﺑ هاﺮﻤﻫ ﺪﻳﺎﺑ ًﺎﻤﺘﺣ و ﻪﺘدور رﺎﻛ ﻪﺑ ﻲﻧﺎﻃﺮﺳ ﺶﻴﭘ تﺎﻌﻳﺎﺿ ﻲﻳﺎﺳﺎﻨﺷ .  :هژاوﺪﻴﻠﻛ  ،ﻮﻳﻮﻨﻳا هﺮﭘ تﺎﻌﻳﺎﺿﺮﻴﻤﺳا پﺎﭘﻲﻧﺎﺷﻮﭙﻤﻫ ،ﻲﭘﻮﻜﺳﻮﭙﻟﻮﻛ ،       Abstract Background: The aim of this study was to investigate the prevalence of pre invasive cervical lesions in patients with abnormal Pap smears in the gynecology clinic of AfzaliPour Kerman Hospital. Materials and Methods: This descriptive-analytic cross-sectional study was conducted on 236 patients with abnormal pap smears in the gynecology clinic of AfzaliPour Hospital. All patients were under colposcopy by the gynecoannocologist and biopsy was performed in case of suspicious lesions in the cervix. In the absence of a lesion, 4 randomized biopsies were taken at 3, 6, 9, and 12 o'clock of the cervix and also took endocervical cytology. Patient pathology samples were then examined by pathologists to determine the degree of consistency of the pre-cancerous cervical lesions in abnormal Pap smear types according to the type of Pap smear and also the type of abnormal Pap smear. Data were analyzed by SPSS software. Results: Pop-smear sensitivity is 96.6% percent for the diagnosis of pre-cancerous lesions. The specificity of Pap smear is 21.8%. Also, the positive predictive value for Pap smear was 41% and the negative predictive value for that was 91.6%. The colposcopy sensitivity for detecting pre-cancerous lesions is 98.8% percent. The actual negative number for colposcopy was 35 and the false positive number was 116 for which the specificity of colposcopy was 23.1%. Also, the positive predictive value for colposcopy was 42% and the negative predictive value for it was 97.2%. Conclusion: According to the results of the study, colposcopy in this center alone does not have a high diagnostic value for diagnosis of cervical lesions and should be accompanied with cytology and biopsy. Keywords: Pre invasive lesion, Pap smear, Colposcopy, Overlap     

بررسی شیوع ضایعات پره اینویزیو(پیش سرطانی) سرویکس در بیماران مراجعه کننده با پاپ اسمیر غیرطبیعی به درمانگاه ژنیکوانکولوژی بیمارستان افضلی پور از ابتدای سال 1395 لغایت پایان سال 1396

http://eprints.kmu.ac.ir/30155/1/6957.pdf

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