宫颈环形电切除术在宫颈上皮内瘤变中的诊断及治疗研究

目的：探讨宫颈环形电切除术（LEEP）在宫颈上皮内瘤变（CIN）的诊断及治疗价值。方法：回顾性分析104例行LEEP治疗的CIN患者资料,观察手术时间、出血量,比较术前宫颈活检与术后病理检查结果及术前后高危型人乳头状病毒（HHPV）的变化。结果：LEEP治疗CIN平均手术时间7.2分钟,平均出血量15ml。阴道镜下宫颈活检与LEEP术后标本的病理诊断完全符合率为74.0%。CIN I、CIN II及CIN III各组LEEP治疗后HHPV转阴率分别为72.7%、66.7%及63.6%,3组相互比较差异无显著性（P〉0.05）。结论：LEEP在切除病变的同时可以有效消除高危型HPV感染,是诊断和治疗CIN安全有效的方法。     

宫颈电环切除术治疗宫颈上皮内瘤变136例

[目的]观察宫颈电环切除术（LEEP）治疗宫颈上皮内瘤变（CIN）的疗效。[方法]对136例CIN患者行LEEP治疗，对其疗效作回顾性分析。[结果]术前术后病理诊断一致占39．71％（54／136）；术后病理诊断级别下降占44．12％（60／136），其中下降一级占24.26％，下降两级占19．12％，下降三级占0．74％：术后病理诊断级别上升占16．18％（22／136），其中上升一级占13．24％，上升两级占2．94％。手术切缘阳性5例。术后半年无CIN占132例，治愈率为97．06％。[结论]LEEP治疗CIN安全有效、简单易行、并发症少，能保留患者的生育功能，在治疗的同时能进行诊断．但术后需定期和规范的随访。     

宫颈电环切除术治疗宫颈上皮内瘤变136例

[目的]观察宫颈电环切除术（LEEP）治疗宫颈上皮内瘤变（CIN）的疗效。[方法]对136例CIN患者行LEEP治疗，对其疗效作回顾性分析。[结果]术前术后病理诊断一致占39．71％（54／136）；术后病理诊断级别下降占44．12％（60／136），其中下降一级占24.26％，下降两级占19．12％，下降三级占0．74％：术后病理诊断级别上升占16．18％（22／136），其中上升一级占13．24％，上升两级占2．94％。手术切缘阳性5例。术后半年无CIN占132例，治愈率为97．06％。[结论]LEEP治疗CIN安全有效、简单易行、并发症少，能保留患者的生育功能，在治疗的同时能进行诊断．但术后需定期和规范的随访。     

宫颈上皮内瘤变环形电切术后再手术的临床分析

[目的]探讨宫颈上皮内瘤变（CIN）环形电切术（LEEP）术后病理级别升高及切缘阳性患者的再手术时机与方法。[方法]回顾性分析2006年12月至2008年12月282例CIN患者中,经LEEP术后再手术57例患者的临床资料,并将LEEP术后病理与再手术治疗后的病理结果进行比较分析。[结果]50例CINⅡ～Ⅲ者再手术后病理降级27例,无改变23例。LEEP术后切缘阳性和阴性者再次术后的宫颈残存病灶分别占68.09%（32/47）和20.00%（2/10）。[结论]LEEP术是CIN进一步诊断及治疗的有效手段,能提高宫颈病变诊断准确性。     

宫颈上皮内瘤变相关危险因素102例分析

[目的]研究宫颈鳞状上皮内瘤变（CIN）的发病相关危险因素及诊疗方法。[方法]102例CIN患者行阴道镜下活检和高频电波刀宫颈环状电圈切除术（LEEP），并同时行高危型HPV检测（HCU）。[结果]102例患者中CINⅠ54例，CINⅡ29例，CINⅢ19例。LEEP术后治愈率为96．1％（98／102），发现病灶残留4例，复发8例（7．8％）。63例高危型HPV阳性，总感染率为61．76％。CINⅡ、Ⅲ组较CINⅠ感染率显著升高（P〈0．05）。术后HPV持续感染率25％。多因素非条件Logistic回归分析显示，年龄、近5年性传播疾病（STD）感染、无性生活防护和性伴的多性是CIN的独立危险因素。[结论]CIN与性行为和下生殖道感染等因素相关。LEEP是CIN诊断和治疗的有效方法。高危型HPV与重度CIN的发生有关，术后高危型HPV检测对预测残留或复发有指导意义。     

子宫颈环形电切术对宫颈癌前病变200例疗效分析

目的 探讨子宫颈环形电切术(LEEP)对宫颈癌前病变的疗效.方法 选取200例宫颈上皮内瘤样病变(CIN)患者,均行LEEP治疗,观察并记录患者的手术时间、术中出血量、不同程度CIN患者治愈例数,对比患者术前阴道镜下宫颈活检和LEEP术后病理组织检查结果,记录随访1个月期间并发症情况.结果 患者所需手术时间6～ 22 min,平均手术时间(7.9±1.8) min;术中出血量16～41 mL,平均术中出血量(21.3±8.9) min.术后病理结果证实:CIN Ⅰ 72例患者,全部治愈,治愈率100％,CINⅡ87例患者,治愈81例,治愈率93.1％,CINⅢ41例患者,治愈37例,治愈率90.2％.不同程度CIN患者治愈率相比,无统计学差异(P＞0.05).术前阴道镜宫颈活检与LEEP术后病理诊断结果比较,CIN Ⅰ病理符合率94.1％,CINⅡ病理符合率83.5％,CINⅢ病理符合率74.5％,不同程度CIN的术后病理符合率相比,差异有统计学意义(P＜0.05).随访1个月,6例出现宫颈粘连,3例宫颈管狭窄,下腹坠痛伴烧灼感7例,并发症发生率8％.结论 LEEP对宫颈癌前病变具有较好的治疗与诊断效果,诊断效果好于术前阴道镜宫颈活检,术后创伤小,并发症少,值得临床推广使用.     

环形电刀切除术治疗宫颈疾病98例临床观察

目的 探讨环形电刀切除术(LEEP)治疗宫颈疾病的临床价值.方法 对98例宫颈疾病,其中包括经TCT(薄层液基细胞学)、阴道镜检查及镜下活检诊断为宫颈上皮内瘤样病变(CIN)31例,采用LEEP治疗,切除组织送病理检查.观察手术时间、出血量、患者反应及术后修复情况.结果 LEEP治疗宫颈疾病成功率为94.4%.平均手术时间为7.1 min,出血量10.3 mL,无继发感染发生.结论 LEEP治疗宫颈病变操作简单、安全、成功率高,尤其适用于CIN.     

系统回顾:宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变及宫颈原位腺癌的对

由于宫颈癌筛查方案的普及，越来越多的宫颈癌前病变及早期宫颈癌得以及时发现及治疗。宫颈环形电切术（loop electrosurgical excisional procedure，LEEP）及冷刀锥切术（cold knife conization，CKC）作为保守手术方案的代表被广泛使用。本文对LEEP与CKC治疗宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）及宫颈原位腺癌（cervical adenocarcinoma in situ，ACIS）的安全性及有效性进行多方面对比，得出以下结果:对于CIN，LEEP虽然较CKC有着更高的术后复发率，但是在手术时间、术中及术后出血量、住院时间、术后感染率、宫颈管狭窄以及阴道镜检查不满意比例等方面有着明显的优势；对于ACIS，LEEP的切缘阳性率显著高于CKC，二者残留病率及复发率无明显差异；考虑到长期并发症，LEEP较CKC有着早产风险低的优势。总之，根据参考文献，LEEP与CKC均为治疗CIN以及ACIS的安全且有效的手段。对于年轻有生育要求患者，LEEP可能是更好的选择，但需术后严密随访。     

电子阴道镜联合LEEP对宫颈上皮内瘤变的诊治价值

目的:探讨宫颈上皮内瘤变的早期诊断及合理治疗,以减少漏诊、过治及复发。方法:选取LEEP 治疗的宫颈上皮内瘤变（CIN）患者136例,对此组患者术前阴道镜直视下活检结果与LEEP术后病理结果进行对比分析。结果:此组病例中,阴道镜下活检结果与LEEP活检病理学诊断结果的完全符合率为59.6%（81/136）,诊断过度35例（25.7%）,诊断不足20例（14.7%）,两种方法的诊断结果差异有统计学意义（P=0.0403)。各个级别CIN 阴道镜下活检结果与LEEP活检病理学诊断结果的完全符合率分别为 43.5%（CINⅠ）、55.1%（CINⅡ）、80.0%（CINⅢ）。LEEP治疗后切缘阳性患者14例,切缘阳性率为10.3％（14/136）。7例切缘阳性患者再次行全子宫切除术,术后4例患者子宫标本中有病灶残留,其病变残留率为57.1％。结论:阴道镜联合LEEP有助于CIN的早期发现、准确诊断及合理治疗,但存在病变残留可能,需重视术后随访。LEEP治疗后切缘阳性是病灶残留的高危因素,对切缘阳性患者的处理有待于进一步探索。     

治糜康栓联合宫颈环形电切术治疗宫颈上皮内瘤变伴高危型HPV感染的临床疗效分析

目的探讨治糜康栓联合宫颈环形电切术（loop electrosurgical excision procedure,LEEP）治疗宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）伴人乳头状瘤病毒（human papilloma virus,HPV）感染的临床疗效.方法按照随机数字表法将76例CIN伴HPV感染患者均分为试验组和对照组,均给予LEEP治疗,试验组加用治糜康栓治疗.比较2组患者阴道出血、排液、宫颈创面愈合情况、临床疗效以及HPV转阴率.结果试验组患者术后阴道排液量、排液时间、出血量、出血时间、盆腔疼痛发生率及宫颈创面愈合时间均明显低于对照组,差异具有统计学意义（P〈0.05）;试验组患者显效率和HPV转阴率均明显高于对照组,差异具有统计学意义（P〈0.05）.结论治糜康栓联合LEEP治疗CIN伴HPV感染临床疗效显著,能够有效改善患者临床症状,安全性高.     

宫颈锥形切除术治疗宫颈癌的疗效观察

目的 探讨宫颈锥形切除术治疗宫颈癌的疗效及不良反应.方法 80例宫颈癌患者根据手术治疗方案的不同随机分为对照组与观察组.对照组患者采用根治性宫颈切除术,观察组患者采用宫颈锥形切除术.观察2组患者的住院时间、手术时间、术中出血以及愈合时间,2组患者手术疗效的比较以及手术过程中常见并发症发生率的比较.结果 对照组患者的住院时间、手术时间、术中出血以及愈合时间均高于观察组患者,差异有统计学意义(P<0.05).对照组患者手术治疗有效率为76.3%,观察组患者手术治疗有效率为92.9%,差异有统计学意义(P<0.05).对照组患者不良反应发生率为21.05%,观察组患者不良反应发生率为10.53%,2组差异有统计学意义(P<0.05).结论 采用宫颈锥形切除术可以有效缩短患者住院时间,减轻患者负担,提高手术治疗宫颈癌的治疗有效率,值得对宫颈锥形切除术在宫颈癌手术中的治疗应用进行进一步的深入研究.     

Cervical Cancer

Worldwide about half a million new cases of cervical cancer occur each year. The incidence is about three times higher in resource-poor countries compared with more developed countries. The disease is reasonably well controlled in countries where routine cervical cytology for detection of premalignant precursors (cervical intraepithelial neoplasia; CIN) is available. Since the causal link between infection by so-called high-risk types of human papillomaviruses (HPV 16, 18 and others) and cervical cancer has been firmly established, the development of virus-specific vaccines has become a major activity both in the academic and corporate sectors. During the natural history of cervical cancer, there are different possible windows for vaccination: (i) prevention of infection that is conferred by neutralizing antibodies can be achieved by immunization with virus-like particles (VLP). Clinical trials with HPV 16 VLPs in humans demonstrated the safety and immunogenicity of the vaccine. Analysis of clinical endpoints such as prevention of infection, CIN and ultimately cervical cancer will require a longer follow-up time; (ii) HPV-as-sociated cervical diseases can also possibly be prevented by postexposure vaccination. As persistent HPV infection appears to be a prerequisite for the development of a malignant tumor, the viral proteins expressed during this state (e.g. E6, E7) are potential targets for cytotoxic T-cell responses to eliminate the infection. Since the target population for this vaccination strategy will consist of mostly young sexually active women that are at risk for reinfection or are potential carriers of infectious virus, it seems to be reasonable to induce a protective immunity via neutralizing antibodies as well. Chimeric virus like particles (CVLP) containing both the L1 (with or without L2) and E7 proteins are promising tools to achieve this goal; and (iii) treatment of cervical cancer by HPV E6/E7-specific immune therapy will most likely only be successful as an adjuvant strategy along with other therapies. On the other hand, based on the data from the first clinical trials, the option of curing precursor lesions by HPV-specific vaccination is considered promising.     

Cervical neuroblastoma

Cervical neuroblastoma is relatively uncommon. It present, most often as a firm mass in the lateral neck. Primary neuroblastomas of the neck usually arise in the cervical sympathetic ganglia. They are the sixth most common head and neck extracranial neoplasms. Neuroblastoma is the most common malignancy in children under 1 year of age. No known cause of Neuroblastoma has been reported.     

Cervical dysplasia

General characteristics of nucleoli in all layers of stratified squamous epithelium were studied in 234 cases of dysplasia and intraepithelial cancer of cervix uteri. Cytomorphometric measurements were carried out. The nuclear-cytoplasmic ratio was determined. Certain regularities pertinent to neoplastic process progression and aging were established. 2,375 patients with moderate dysplasia and 1,625 patients with marked dysplasia underwent clinical examination. Various schemes of treatment and long-term results were evaluated. Rationale for all-round examination and individually-tailored schemes of treatment is discussed. The data on the end results in 150 untreated cases of dysplasia are presented. The importance of detection and treatment of dysplasia in the control of cervical cancer is suggested.     

Cervical cancer screening

There is abundant evidence that cervical cancer screening with conventional cytology(CC)has reduced mortality from cervical cancer. Based on the evidence, CC has been implemented as a modality of the population-based screening for the last several decades in Japan. Several issues are currently faced during screening. For instance, very low coverage is one of the greatest unsolved problems. At the same time, a reliable system is required to monitor specimen adequacy and to calculate detection rates of not only invasive cancer, but also cervical intraepithelial neoplasia(CIN), for the quality control and evaluation of screening efficacy. Recently, two new modalities may be applicable for cervical cancer screening. One is liquid-based cytology(LBC)and the other is the HPV test. LBC and CC did not differ significantly in terms of sensitivity and specificity for detection of CIN2+or CIN3+. HPV tests are superior to CC in sensitivity but are inferior in specificity for detection of CIN2+or CIN3+. Because there is a possibility reducing mortality from and incidence of invasive cervical cancer, implementation of these modalities to Japan should be taken into consideration. Prior to this, however, it is necessary to organize a system to compare performance indicators reflecting the effectiveness of the new modalities to those of CC in a population-based screening. Also, these results must be disclosed for a steady perspective on the cervical cancer screening in Japan.     

Cervical thymic cyst

Neck is a common site for the appearance of cystic masses. Although cervical thymic cyst is a rare lesion it should be included in the differential diagnosis. Because of the rarity of “clinically significant” remanants of thymus in neck, the two cases of benign cervical thymic cyst have been discussed in the present article.     

Cervical cancer screening

Although primary prevention of human papillomavirus (HPV) infections that are causally associated with invasive cervical cancer may be within our grasp, it is unlikely that these approaches will replace existing cervical cancer screening strategies for many years. Experts agree and data support periodic cytology screening for young-adult women using one of several technologies. Recent analyses of cost-effectiveness suggest that the addition of molecular HPV DNA testing for women aged over 30 years may allow the screening interval to be lengthened to 3 years for most women. Women at high risk for HPV infection and its associated cellular atypias warrant closer monitoring and follow-up. These patients would include organ transplant recipients, women exposed to diethylstilbestrol (DES), and HIV-infected women.