肉眼观察法在宫颈癌及癌前病变筛查中的应用

目的：探讨醋酸肉眼观察（VIA）和碘染色肉眼观察（VILI）在宫颈癌及癌前病变筛查中的可行性。方法：以天津市大港区2003例妇女为研究对象,进行癌症综合知识、危险因素的问卷调查．用VIA和VILI行宫颈癌及其癌前病变筛查。VIA或VILI阳性者行电子阴道镜检查,阴道镜检查异常者行阴道镜下宫颈活检,病理学检查明确诊断。结果：单纯VIA阳性者257例。VIA或VILI阳性者共计265例．其中197例阴道镜检查异常,在阴道镜指导下行宫颈活检,以病理学检查结果作为诊断的金标准,宫颈上皮内瘤变（CIN）的检出率为7．04％,其中CINI116例,CINⅡ14例,CINIII11例。结论：在资源有限、经济欠发达的地区,由经过培训的医生实施VIA或VIU做宫颈癌初筛的方案可行。     

肉眼观察法在宫颈癌及癌前病变筛查中的应用

目的：探讨醋酸肉眼观察（VIA）和碘染色肉眼观察（VILI）在宫颈癌及癌前病变筛查中的可行性。方法：以天津市大港区2 003例妇女为研究对象,进行癌症综合知识、危险因素的问卷调查,用VIA和 VILI行宫颈癌及其癌前病变筛查。VIA或VILI阳性者行电子阴道镜检查,阴道镜检查异常者行阴道镜下宫颈活检,病理学检查明确诊断。结果：单纯VIA阳性者257例,VIA或VILI阳性者共计265例,其中197例阴道镜检查异常,在阴道镜指导下行宫颈活检,以病理学检查结果作为诊断的金标准,宫颈上皮内瘤变（CIN）的检出率为7.04%,其中CINⅠ116例,CINⅡ14例,CINⅢ11例。结论：在资源有限、经济欠发达的地区,由经过培训的医生实施VIA或VILI做宫颈癌初筛的方案可行。     

宫颈巴氏涂片与LCT在低收入妇女妇科普查中的应用

目的探讨宫颈巴氏涂片与液基细胞学（LCT）在低收入已婚妇女宫颈癌筛查中的应用价值。方法2008年1月至6月上海市浦东新区妇幼保健院对所在社区6416例低收入已婚妇女（低收入组）采用宫颈巴氏涂片进行了宫颈癌筛查,其中322例同期行LCT,并与同期来上海市浦东新区妇幼保健院做宫颈癌筛查行LCT的294名妇女进行对照（对照组）。结果①宫颈刮片巴氏异常者（≥Ⅱb级）低收入组中22例（0．34％）,其中Ⅱb级12例（0．19％）,Ⅲ级10例（0．16％）,无Ⅳ级及Ⅴ级。15例（Ⅱb5例,其余Ⅲ级）行阴道镜下活检,病理结果CIN8例,其中CIN12例,CIN2和CIN3各3例;②低收入组同期行LCT的322例妇女中,细胞学≥ASCUS共41／322例（12．73％）,其中ASCUS15例,HSIL 1例,行阴道镜下活检病理结果CIN5例（CIN1和CIN2各2例,CIN31例）;HSIL1例为子宫颈鳞状细胞癌。对照组：细胞学≥ASCUS 22／294例（7．48％）。其中ASCUS 11例行阴道镜下活检。病理结果仅CIN 21例;2例LSIL;1例为CIN2。两组AGC各1例经阴道镜下活检均无异常;③低收入组中322例行宫颈刮片和LCT做自身对照：315例巴氏均为Ⅰ级,LCT正常;巴氏Ⅱb级2例,LCT均为ASCUS,病理分别为CIN1和CIN2;巴氏Ⅲ级3例,LCT检查,其中2例为ASCUS,阴道镜活检仅1例病理为CIN2。结论宫颈细胞学是筛查宫颈病变的有效手段,巴氏涂片法在基层对低收入人群仍可为主要筛查方法。有条件者可采用LCT,以提高宫颈疾病筛查的敏感性。     

醋酸-碘试验在宫颈癌早期筛查中的价值

目的：评价宫颈醋酸－碘试验（VIA-VILI）筛查宫颈癌早期病变的价值。方法：2008年5月—9月对天津市大港区迎新街社区的2 006例30~59岁有性生活妇女进行宫颈癌早期病变筛查。采集宫颈脱落细胞留做薄层液基细胞学（LCT）检测。然后应用5%醋酸及希乐液涂抹法进行VIA-VILI,VIA-VILI阴性而LCT结果异常者、VIA阳性者或VILI阳性者行阴道镜检查及活检病理检查。结果：最终有2 000例纳入试验,VIA-VILI阳性并取活检347例,病理结果显示≥CINⅡ者47例（占13.54%）;LCT阳性并取活检134例,病理结果显示≥CINⅡ的50例（37.31%）,其中39例为VIA-VILI及LCT均为阳性者。筛查CINⅡ及以上宫颈病变和宫颈癌的敏感度、特异度和约登指数,VIA-VILI方法分别为81%、84.6%和0.656,LCT检查分别为90.3%、88.4%和0.787。结论：VIA-VILI试验筛查宫颈病变的效率虽低于LCT检查,但方便快捷、价格低廉,在经济不发达地区或低收入人群中有一定应用价值。     

液基薄片细胞学检查在宫颈癌筛查中的应用

目的评价液基薄片细胞学检查在宫颈癌筛查中的作用。方法回顾性分析241例宫颈液基薄片细胞学异常，包括非典型鳞状上皮细胞（atypical squamous cells，ASC）121例、低度鳞状上皮内病变（low grade squamous intraepithelial lesions，LSIL）68例、高度鳞状上皮内病变（high grade squamous intraepithelial lesions，HSIL）49例，非典型腺上皮细胞（atypical gladullar cells，AGC）3例，均行阴道镜下宫颈活检病理诊断。结果病理诊断为宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）Ⅰ42例，CINⅡ40例，CINⅢ29例，HPV感染40例，宫颈炎90例。单纯HPV感染组的平均年龄低于CIN组（P＜0．05），近半数的40岁以下CINⅢ患者有宫颈癌的高发因素。22．5％的CIN和47．5％的宫颈HPV感染者无症状。87．8％HSIL的宫颈活检病理诊断为CINⅡ、Ⅲ。结论进行宫颈癌的筛查十分必要，液基薄片细胞学检查可以提高CIN的检出。     

内蒙古镶黄旗地区妇女宫颈病变筛查现状

目的探讨宫颈细胞学(包括巴式涂片及超柏氏薄层液基细胞学)及阴道镜检查筛查内蒙古镶黄旗地区妇女宫颈病变的现状及临床意义。方法2004年7月至2009年1月对内蒙古镶黄旗地区的642例28～67岁有性生活妇女进行宫颈病变筛查,其中557例妇女行传统宫颈巴式涂片法,85例妇女行宫颈超柏氏薄层液基细胞学,并对宫颈细胞学异常者(≥ASCUS)行阴道镜检查及活检。结果642例妇女中宫颈细胞学阳性(≥ASCUS)者34例,占5.3%(34/642),其中ASCUS者22例,占64.7%(22/34);低度鳞状上皮内病变(LSIL)者6例,占17.6%(6/34);高度鳞状上皮内病变(HSIL)者6例,占17.6%(6/34),其中有1例肯定为宫颈癌。宫颈细胞学阴性608例,占94.7%(608/642)。宫颈细胞学阳性34例人群中,行阴道镜活检病理检查者有25例,其中慢性宫颈炎13例(52.0%);CIN1为5例(20.0%);CIN2为4例(16.0%);CIN3为1例(4.0%);浸润癌为2例(8.0%)。结论应重视并及时进行经济不发达地区妇女人群宫颈病变的早期筛查,传统宫颈巴式涂片法及阴道镜活检及病理学检查为可行的筛查方法,有条件者可进行宫颈薄层液基细胞学结合阴道镜活检及病理学检查,对提高早期宫颈癌筛查的准确性效果明显。对内蒙古等西部地区,应在完善技术力量支持、筛查质量控制、建立筛查后的转诊制度及治疗的绿色通道等方面,以降低宫颈癌的发病率。     

贵州老年女性宫颈癌筛查的分析评价

目的:评价宫颈细胞学、高危型人乳头瘤病毒(HPV)DNA检测及阴道镜检查对老年女性宫颈病变筛查的效力。方法:分析于贵州医科大学附属医院妇科阴道镜门诊行阴道镜检查并行阴道镜下病理活检的602例50岁以上老年女性的宫颈癌筛查资料,比较细胞学、高危型HPV DNA检测与阴道镜检查在老年女性宫颈病变筛查中的意义。结果:602例老年女性中,病理学诊断为宫颈高级别以上病变221例(CINII/III 133例,宫颈癌88例)占36.7%。宫颈细胞学筛查宫颈高级别以上病变,以ASCUS为分界点的灵敏度、特异度、阳性预测值和阴性预测值分别为86.7%、47.3%、43.4%和88.4%;以LSIL为分界点的灵敏度、特异度、阳性预测值和阴性预测值分别为35.2%、88.7%、59.2%和74.6%;以HSIL为分界点的灵敏度、特异度、阳性预测值和阴性预测值分别为30.5%、96.0%、78.0%和74.8%;高危型HPV DNA分型检测宫颈高级别以上病变的灵敏度、特异度、阳性预测值和阴性预测值分别为71.2%、32.3%、34.3%和69.4%;高危型HPV DNA检测联合细胞学(≥ASCUS)检查筛查宫颈高级别以上病变的灵敏度、特异度、阳性预测值和阴性预测值分别为100%、22.67%、54.7%和100%;阴道镜诊断与子宫颈病理诊断的完全符合率为63.51%,一致性检验Kappa值为0.631,阴道镜印象宫颈高级别病变及以上病变的敏感度为74.3%、阳性预测值为72.2%、阴道镜对于宫颈低级别病变及以下病变的特异度为89.4%,阴性预测值为90.4%,假阳性率为10.6%,假阴性率为25.7%。结论:对老年女性,细胞学检查是有效的宫颈癌筛查方法,细胞学联合HPV DNA筛查可使敏感度和阴性预测值提高,阴道镜检查可提高诊断率,三者结合应用将更有利于宫颈病变的科学管理。     

宫颈细胞学和电子阴道镜在宫颈病变早期诊断中的应用研究

目的进一步评价细胞学和电子阴道镜在宫颈病变的早期诊断中的价值.方法回顾性分析431例宫颈涂片和阴道镜检的结果,与活检组织病理学的结果进行对比研究.结果 431例中检出宫颈上皮内瘤变(CIN)Ⅰ 39例、CIN Ⅱ 36例、CIN Ⅲ 32例、宫颈鳞癌11例和宫颈湿疣27例,其余286例为慢性宫颈炎.宫颈涂片检出了93.5%宫颈病变,阴道镜检出了95.9%宫颈病变,细胞学与阴道镜下活检联合应用无漏诊.结论细胞学与阴道镜下活检联合应用能提高宫颈病变的检出率,阴道镜检查能明显提高宫颈湿疣的检出率.     

阴道镜诊断宫颈病变的评价

目的评价阴道镜对宫颈病变的诊断价值。方法对我院92例阴道镜检查宫颈病变患者行宫颈刮片及阴道镜检查，并将宫颈刮片、阴道镜检查和病理学检查结果进行比较，探讨三者在宫颈病变中的诊断意义。全组均做细胞学涂片和阴道镜检查，电子阴道镜采用深圳金科威公司推出的阴道镜数字成像系统，阴道镜下可疑部位取活检，最后送病理检查。结果电子阴道镜检查的灵敏度为96．7％，特异度为48．4％，阳性预测值为47．5％，阴性预测值为3．0％。结论阴道镜检查可弥补宫颈刮片的不足而避免漏诊，在异常部位取活检可提高诊断准确率，阴道镜检查亦存在灵敏度高而特异性低的特点，尤其对初学者易出现，应注意鉴别，积累经验，提高诊断准确率。     

阴道镜检查对HR-HPV阳性、细胞学阴性女性宫颈上皮内瘤变及宫颈癌筛查的意义

目的:探讨阴道镜检查对HR-HPV阳性、细胞学阴性女性宫颈上皮内瘤变(CIN)及宫颈癌筛查的意义。方法:对就诊于青岛大学附属医院的575例HR-HPV阳性、细胞学阴性妇女行阴道镜检查及宫颈活检术,分析年龄、转化区、病毒负荷量与宫颈活检病理的关系。结果:575例HR-HPV阳性、细胞学阴性的妇女中,宫颈高级别病变(CINⅡ+)的检出率为7.48%(43/575)。患者年龄为30~39岁、40~49岁、≥50岁的宫颈高级别病变患病风险分别是30岁的1.44(0.45~4.35)、0.97(0.30~3.11)、1.78(0.48~6.68)倍。不同宫颈转化区TZ1、TZ2、TZ3的CINⅡ+检出率分别为7.86%(32/407)、7.79%(6/77)和5.49%(5/91)。随着宫颈病变程度加重,病毒负荷量的中位数逐渐增加,宫颈高级别病变较低级别病变及慢性炎症的病毒负荷量较高,且差异具有统计学意义(P0.05)。结论:HR-HPV阳性、细胞学阴性女性存在一定的患宫颈高级别病变的风险,阴道镜下宫颈活检术可减少宫颈高级别病变的漏诊。病毒负荷量较高者宫颈高级别病变的患病风险较大,但患病风险与年龄无明显关系。     

Cerclaje para tratar la insuficiencia cervical. Nuestra experiencia a lo largo de la última década

We review the cervical cerclages performed at our institution in the last decade. The outcome of elective cerclages was highly satisfactory. Several clinical, analytical and ultrasound criteria were useful to retrospectively determine a subgroup of patients with an especially poor prognosis after cerclage. However, even in this subgroup, cerclage was successful in 30%. The management of emergency cerclage should be individualized; patients with less cervical dilation, less effacement and fewer inflammatory signs are those most likely to benefit from emergency cerclage.     

Comparison of elective and empiric cerclage and the role of emergency cerclage

We describe the maternal, obstetric, and neonatal outcomes of patients undergoing elective, empiric, and emergency cervical cerclage at our institution in an attempt to determine predictive factors for adverse perinatal and maternal outcomes. A retrospective chart review was conducted on patients who underwent cervical cerclage placement over a 7-year time span. Of 55 charts, 40 contained complete peripartum data satisfactory for review; 7 elective, 15 empiric, and 18 emergency cerclages were analyzed. There was no perinatal mortality in the elective group, and 5/7 patients delivered at term. The empiric population experienced a 20% neonatal mortality; 6/15 gestations progressed to term. The perinatal mortality was 44% in the emergency group and 2/18 patients delivered at term. Relative to neonatal outcome, elective cerclage was statistically significantly better than emergent cerclage; there was no statistically significant difference between the elective and empiric groups nor between the empiric and emergent groups. This relatively small series with a large number of variables appeared to favor an elective procedure rather than an empiric one. Although emergent cerclage was associated with only a 56% neonatal survival, it did have value in some patients.     

Cervical surveillance as an alternative to elective cervical cerclage for pregnancy management of suspected cervical incompetence

OBJECTIVE: The aim of the present study was to compare the outcome of pregnancies among patients with suspected cervical incompetence treated either by elective cervical cerclage or an alternative management program involving cervical surveillance. DESIGN, SETTING AND METHODS: A prospective cohort study was performed in two groups of patients at risk of cervical incompetence with singleton gestations attending the Royal Women's Hospital, Melbourne, Australia, from 1996 to 2000. The first group was managed by their obstetric carers with an elective cerclage, while the second group was managed conservatively as part of a cervical surveillance program offered to patients attending the Department of Perinatal Medicine for pregnancy care. This program consists of weekly visits from 16 weeks' gestation and involves alternating transvaginal ultrasound assessment of cervical morphometry with cervico-vaginal bacteriology and fetal fibronectin swabs. Empiric insertion of a cerclage is undertaken when there is evidence of significant cervical shortening (cervical canal <2.5 cm in length at 相似文献   

复发性流产患者子宫颈机能不全的诊断和治疗

子宫颈机能不全（CIC）是引起晚期流产、胎儿丢失的主要原因，应重视复发性流产患者CIC的诊断和治疗。其诊断方法和标准随着临床实践经验的总结取得了一定进展。虽然子宫颈环扎术是治疗CIC的主要手段，但对子宫颈环扎术的指征以及手术方式仍然存在诸多争议。文章对CIC的诊断与治疗进行讨论，旨在寻求最安全有效的治疗以获得最佳的妊娠结局。     

2019年SOGC《宫颈机能不全与宫颈环扎术临床实践指南》解读

        宫颈机能不全（cervical incompetence,CIC）系宫颈解剖结构或功能异常,导致在足月妊娠前出现进行性、无痛性宫颈缩短、扩张、展平及漏斗状宫颈,妊娠中晚期无法维持妊娠,发生率为0.1%～1.0%。是复发性中晚期妊娠流产及早产的重要原因。作为临床诊断性疾病,CIC缺乏客观的诊断标准,宫颈环扎术是目前治疗宫颈机能不全的惟一术式和有效方法［1］。2019年加拿大妇产科医师协会（SOGC）颁布了最新版指南《No.373宫颈机能不全与宫颈环扎术临床实践指南》［2］,替代2013年No.301旧版指南,旨在指导临床医生明确宫颈机能不全的高危人群,并为宫颈环扎手术术式及辅助治疗措施的个体化选择提供参考意见。本文就该指南的推荐意见进行简要解读。     

复发性流产患者子宫颈机能不全的诊断和治疗

子宫颈机能不全（CIC）是引起晚期流产、胎儿丢失的主要原因，应重视复发性流产患者CIC的诊断和治疗。其诊断方法和标准随着临床实践经验的总结取得了一定进展。虽然子宫颈环扎术是治疗CIC的主要手段，但对子宫颈环扎术的指征以及手术方式仍然存在诸多争议。文章对CIC的诊断与治疗进行讨论，旨在寻求最安全有效的治疗以获得最佳的妊娠结局。     

Cervical insufficiency: Re-evaluating the prophylactic cervical cerclage

Historically, placement of a cervical cerclage was based almost entirely on the obstetrical history. Over the past two decades however, we have recognised that history alone may not be the only indication for cerclage but rather, complementing the obstetrical history with ultrasonographic and biochemical findings may better identify those women who may benefit most from the placement of a cervical cerclage. Review of the literature appears to suggest that the best approach towards the management of a cervical insufficiency is to first categorise women as being either high risk of low risk-based on obstetrical history. Although women with an obstetrical history of at least three 2nd trimester losses are likely to benefit from a prophylactic cerclage than those without this history may better be managed with progesterone and serial cervical length measurements. This approach can in turn be used to identify those women with early cervical shortening that may require an emergency cerclage. Although randomised controlled trials are still lacking, recent studies suggests that this approach may be more effective especially when combined with markers of intra-amniotic inflammation. As for the prophylactic cerclage itself, with the abdominal cerclage being less invasive given the possibility of a laparoscopic placement, it may prove to be a more effective alternative to the conventionally placed McDonald cerclage. This however, remains to be evaluated more carefully.     

Reducing the burden of glandular carcinomas of the uterine cervix

Widespread use of the Papanicolaou test for the screening of cervical cancers has lead to a significant decline in overall incidence and mortality rates over the past 3 decades. When different histologic types of cervical cancers are considered and trends are reexamined, it becomes apparent that observed declines are reflective of squamous cell carcinomas predominantly; the rates for adenocarcinomas continue to rise. This rise in incidence may be due to the greater difficulty in screening for glandular precursor lesions that often arise high within the endocervical canal. Reducing the incidence and mortality rates that are associated with adenocarcinomas can be accomplished by using improved screening techniques and large-scale implementation of cervical cancer vaccines that target the predominant oncogenic human papillomavirus types that are associated with adenocarcinoma.     

Human papillomavirus

Human papillomaviruses are ancient small DNA viruses and represent the most common sexually transmitted infection in the world. In the majority, HPV infection is cleared by an incompletely understood immune response. HPV is a necessary but not sufficient cause of cervical cancer, and responsible for a proportion of other anogenital cancers including vulval, vaginal, anal and oropharyngeal. Oncogenesis is likely mediated through viral proteins which hijack host-cell machinery in epithelial keratinocytes and disrupt host tumour-suppressor proteins. Much work has been undertaken to further characterise the natural history of HPV infection and cervical disease. Such efforts have been translated to important public health interventions like the introduction of HPV tests in cervical screening. HPV vaccination programmes are expected to further reduce the incidence of high-risk HPV infections and resultantly HPV-related disease.     

紧急宫颈环扎术联合不同宫缩抑制剂的效果和安全性评价

目的评价宫颈环扎术后联合不同宫缩抑制剂的效果和安全性。方法回顾性分析2015年1月至2019年12月在首都医科大学附属北京世纪坛医院妇产科行紧急宫颈环扎术,并在术后使用不同宫缩抑制剂的56例单胎妊娠患者,观察药物疗效、不良反应以及妊娠结局。结果紧急宫颈环扎术后使用阿托西班+吲哚美辛栓组的药物起效时间最短,成功率较高(P<0.05);盐酸利托君组药物不良反应较高60.00%,主要为心动过速(P<0.05)。结论紧急宫颈环扎术后联合阿托西班及吲哚美辛栓能延长妊娠时间,药物不良反应发生率较低,值得临床推广。