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1、 摘 要子宫颈上皮内瘤样变（cervical intraepithelial neoplasia，CIN）及宫颈癌变是妇科高发疾病，而CIN是宫颈演变发展过程中的癌前期病变阶段，此阶段持续时间相当长，所以CIN的早期诊断和治疗是防治宫颈癌变关键的环节。在子宫颈病变的诊断过程中，采用简便、有效的方法，对及时发现与诊断CIN及宫颈癌变具有十分重要的意义。一般而言，对宫颈病变的准确诊断应依赖病变组织的病理检查，但病理检查为损伤性，费用高，病人接受性差，基层医院条件差者不能开展。能否采用比病理检查更简单、更适用而又准确的检查方法早期诊断CIN与宫颈癌变是值得研究的课题。国内外虽对阴道镜诊断CIN）及宫
2、颈癌变进行了大量研究，但仍只是作为宫颈癌前病变和宫颈癌变的三级诊断方法中的第二种方法进行强调，对电子阴道镜与宫颈病变组织病理检查之间的差异比较仍缺乏系统研究。如果电子阴道镜能较准确地诊断CIN及宫颈癌变，对宫颈癌前病变及宫颈癌变的防治起到十分重要的积极作用。SPSS是软件英文名称的首字母缩写，原意为Statistical Package for the Social Sciences，即“社会科学统计软件包”，它是世界上最早的统计分析软件，在自然科学、技术科学、社会科学的各个领域内被广泛应用，世界上许多有影响的报刊杂志纷纷就SPSS的自动统计绘图、数据的深入分析、使用方便、功能齐全等方面给予了
3、高度的评价与称赞。基于此，对986例子宫颈病变患者行电子阴道镜检查与组织病理检查，采用SPSS13.0统计软件进行统计分析，通过系数检验和2检验比较、分析电子阴道镜检查与病理检查结果的诊断符合情况，通过相关分析探讨电子阴道镜各种图像与CIN及宫颈癌的相关性，从而说明电子阴道镜在宫颈临床诊断中的价值。应用SPSS软件分析结果表明：电子阴道镜和病理检查两种方法对宫颈癌前病变和浸润癌诊断符合率较高（CIN 90.06%，CIN+浸润癌 90.10%），结果吻合度较强，有统计学意义 (=0.858，=0.735)。2检验结果表明，阴道镜检查诊断宫颈癌前病变和浸润癌的阳性率82.15%（810/986）
4、比病理检查阳性率77.69%（766/986）高，差异有显著性意义（2=5.437，P=0.000）。阴道镜图像与CIN及浸润癌呈显著正相关关系（r=0.207，P0.001）。与病理检查相比，电子阴道镜检查能较准确地诊断CIN及宫颈癌变，具有重要的临床应用价值，对宫颈癌前病变及宫颈癌变的防治起到十分重要的积极作用。关键词 宫颈上皮内瘤样变；宫颈癌；SPSS软件；病理检查；电子阴道镜 AbstractCervical intraepithelial neoplasia (CIN) and uterine cervix cancer are the most common diseases in
5、 department of gynecology. To make a early diagnosis and give following treatment in time is the key point for the control of uterine cervix cancer, as CIN will last for a long time befor becoming cancer. During the diagnostic procedure of CIN, it is quite important for finding out the disease in ti
6、me to use a simple and effective method. Generally speaking, an exact diagnosis of CIN should be based on the result of pathology test. But the pathology test couldnt be accepted by all the patients, especially for the poor district, just because of its damaging and expensive fees. Whether its possi
7、ble to find a more simple, suitable and exact way to diagnose CIN and uterine cervix cancer earlier become a topic which worth investigative. The Electronic Colposcopy is usually considered as a second one among the three-step diagnositic methods, although it has been researched by the researchers a
8、ll over the world. If the Electronic Colposcopy could give a diagnosis as exact as pathology test dose, it will play an active part in the control of CIN and uterine cervix cancer.SPSS is an abbreviation of the English name of a software, which means Statistical Package for the Social Sciences. It i
9、s the original statistical analysis software all over the world and widely uesd in many fields, such as natural science, technology science, society science, and so on. Some influencing newspapers and periodicals give a high regard to the analysis function of the SPSS software. Then, 986 patients wh
10、o were checked by the Electronic Colposcopy and the pathology test were sampled. Through coefficient analysis and 2 analysis, we compared and analyzed the coincidence ratio of the result of Electronic Colposcopy and the pathology test. The relevance between the pictures of the Electronic Colposcopy
11、and the diseases including CIN and cervical cancer was disscussed by the relevance and regression analysis. Electronic Colposcopy and pathology test have significant coincidence ratio in the diagnosis of CIN and cervical infiltrating carcinoma,（CIN 90.06%，CIN+ infiltrating carcinoma 90.10%）. There i
12、s a statistical significance (=0.858，=0.735) between the goodness of fit of two methods. The positive ratio the CIN and infiltrating carcinoma detecked by Electronic Colposcopy is 82.15% (810/986). Meanwhile, it is 77.69 %( 766/986) by pathology test. The result of 2 analysis show that the differenc
13、e between the two tests have statistical significance, (2=5.437，P=0.000). The pictures taken by the Electronic Colposcopy have significant positive correlation with CIN and infiltrating carcinoma(r=0.207，P0.001). Compared with pathology test, Electronic Colposcopy can diagnose the CIN and cervical c
14、ancer correctly. Electronic Colposcopy has its important clinical value on preventing and curing CIN and cervical cancer. Keywords cervical intraepithelial neoplasia; cervical cancer; SPSS software; pathology test; the Electronic Colposcopy; 目 录摘 要Abstract 第1章 绪论11.1研究背景11.2研究目的和意义51.3国内外研究进展61.4研究内
15、容61.5论文章节安排6第2章 相关技术与SPSS软件技术基础82.1相关概念与技术理论介绍82.1.1相关概念82.1.2阴道镜检查技术理论介绍82.2 SPSS软件介绍102.2.1 SPSS的概念102.2.2 SPSS功能概述102.2.3系数检验、2检验以及相关性检验的分析标准122.2.4如何应用SPSS实现分析过程13第3章 试验设计与实施153.1试验背景、目的、方法设计（技术路线）153.1.1试验背景153.1.2试验目的173.1.3试验方法（技术路线）183.2试验所搜集的试验因素、数据183.2.1病例选择183.2.2电子阴道镜检查方法193.2.3电子阴道镜诊断标准193.2.4 LEEP手术方法193.2.5 病理检查方法203.2.6 病理检查诊断标准203.2.7 试验数据213.3本章小结22第4章 试验数据分析234.1试验经过、讨论（实际试验中的真实数据列表、分析）234.1.1阴道镜检查结果与病理检查结果比较的系数检验234.1.2阴道镜检查结果与病理检查结果比较的四格表的2检验和系数检验264.1.3阴道镜检查结果各图像与CIN及浸润癌的相关性统计学分析294.2试验结果324.3策略与措施334.4本章小结33第5章 总结与展望34参考文献39致 谢43
