Cheung S T, Gach J E, Lewis F M
Department of Dermatology, Worcestershire Royal Hospital, Worcester, UK.
J Obstet Gynaecol. 2006 Jul;26(5):435-7. doi: 10.1080/01443610600747140.
A retrospective study of the referral patterns to a specialist vulval clinic was performed. A total of 200 clinical records were reviewed of new patients seen between January 2004 and June 2005. A provisional diagnosis was stated in 45.5% of referrals, of which 27.5% had the diagnosis changed at the clinic. The majority of referrals were from general practitioners (GPs) (77%) and smaller proportions from gynaecologists (11%), dermatologists (9%) and others (3%). The most common conditions seen were lichen sclerosus (39%), eczema/lichen simplex (30.5%), lichen planus (11.5%), pain syndromes (10.5%) and others (8.5%). Lichen sclerosus was accurately diagnosed in 54.5% of referrals but for eczema/lichen simplex it was only recognised in 11.5% of referrals. Nine cases of lichen sclerosus had been referred by gynaecologists after histological confirmation, for advice on management. Education of vulval diseases to non-specialists should focus on conditions that they are most likely to encounter and find difficult to manage. This study illustrates an effective method to define what the local teaching requirements are.
对外阴专科诊所的转诊模式进行了一项回顾性研究。共查阅了2004年1月至2005年6月期间新患者的200份临床记录。45.5%的转诊病例给出了初步诊断，其中27.5%在诊所时诊断发生了改变。大多数转诊来自全科医生（77%），较小比例来自妇科医生（11%）、皮肤科医生（9%）和其他人员（3%）。最常见的病症为硬化性苔藓（39%）、湿疹/单纯性苔藓（30.5%）、扁平苔藓（11.5%）、疼痛综合征（10.5%）和其他（8.5%）。54.5%的转诊病例准确诊断出硬化性苔藓，但湿疹/单纯性苔藓在转诊病例中仅11.5%得到识别。9例硬化性苔藓病例经组织学确诊后由妇科医生转诊，以获取治疗建议。对外阴疾病非专科医生的教育应侧重于他们最有可能遇到且难以处理的病症。本研究说明了一种确定当地教学需求的有效方法。
