液基细胞学联合P16INK4a和cyclin E用于诊断宫颈上皮内瘤变的意义

目的:探讨液基细胞学(liquid-based cytology test,LCT)联合p16INK4A和cyclin E用于诊断宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的价值。方法:225例宫颈病变患者,其中宫颈鳞状细胞癌(squamous cell carcinomas,SCC)56例,高度鳞状上皮内病变(high grade squamous intraepithelial lesions,HSIL)41例,低度鳞状上皮内病变(low grade squamous intraepithelial lesions,LSIL)76例,不典型鳞状细胞(atypical squamous cell lesions,ASC)32例,正常范围(within normal limits,WNL)20例。采用免疫组化法检测p16INK4A和cyclin E的表达。比较单纯LCT及LCT联合p16INK4A和cyclin E的病理诊断符合率。结果:单纯LCT病理诊断符合率为LSIL 52.08%,HSIL 77.14%,SCC 98.21%;LCT联合p16INK4A和cyclin E的病理诊断符合率为LSIL 87.50%,HSIL97.14%,SCC 100%,差异有统计学意义(P(0.05)。32例ASC的LCT联合p16INK4A和cyclin E的阳性病理诊断符合率为85.71%,与单纯LCT的差异有统计学意义(P(0.05)。结论:LCT联合P16INK4a和cyclin E可用于筛查CIN,尤其对ASC的确诊,较单纯LCT有更高的病理诊断符合率,可以提高CIN的诊断准确性。     

人乳头瘤病毒(HPV)感染患者的管理现状

人乳头瘤病毒(human papillomavirus,HPV)在自然人群中有高感染率,性活跃人群中近80%有HPV感染史,HPV持续感染与宫颈癌前病变及宫颈癌密切相关。目前HPV检测已公认作为未明确意义的不典型鳞状上皮细胞(atipical squamous cells of unkown significance,ASCUS)分流指标,同时用于明确低度宫颈鳞状上皮内瘤变(low-grade squamous intraepithelial leision,LSIL)治疗方式选择,高度宫颈鳞状上皮内瘤变(high-grade squamous intraepithelial lesion,HSIL)的随访和宫颈癌复发预测指标。由于人们对于HPV过度关注,造成HPV检测频繁,多种HPV检测方法同时进行造成医疗资源浪费,给病人带来恐慌。因此如何对HPV感染患者进行规范化统一管理逐渐引起专家重视,尤其是对单纯HPV管理,合理进行HPV定量及分型检测,可以提高早期宫颈癌筛查率,降低医疗费用。     

生殖道人乳头瘤病毒感染与宫颈病变、宫颈癌相关性研究

目的 了解生殖道人乳头瘤病毒感染与宫颈病变、宫颈癌的关系，以便早期发现和治疗宫颈上皮内瘤样变（CIN）和原位癌。方法 应用TCT液基细胞学薄片检测法对宫颈病变做阴道细胞学分析，对CIN进行分级（Ⅰ、Ⅱ、Ⅲ）鉴定。对高危病人（如ASCUS、CIN、宫颈原位癌）应用基因杂交捕获法（Hybrid Capture，HC-Ⅱ）分型检测HPV，同时用PCR法检测HPV—DNA，进一步做HPV分型鉴定。最后所有病人均进行阴道镜检查及病理组织学诊断。结果 2003年2月～2005年3月将标本送往广州金域医学检验中心进行TCT和HPV检测（HC—H），其中TCT检测1086例，发现不典型鳞状细胞39例、CINⅠ25例、CINⅡ3例、CINⅢ5例，原位癌3例。高危病人（如ASCUS、CIN、宫颈原位癌）进行HC—Ⅱ检测40例，阳性25例（其中原位癌、CINⅢ和CINⅡ均阳性）。结论 HPV感染与宫颈病变，特别是宫颈癌、宫颈癌前病变的发生有明显的相关性，病变越重，HPV的感染率越高。提示宫颈癌的防治重点应放在高危型HPV感染者。     

子宫颈高级别鳞状上皮内病变选择性应用全子宫切除术治疗的中国专家共识（2022年版）

子宫颈高级别鳞状上皮内病变（high grade squamous intraepithelial lesion,HSIL）是子宫颈癌的癌前病变,包括子宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）2级和3级、中重度鳞状上皮不典型增生以及原位癌［1］。子宫颈HSIL的规范治疗是减少浸润性子宫颈癌的重点内容。     

p16~(INK4a)在液基细胞学筛查宫颈病变中高危人群的临床价值

目的:利用液基细胞学标本探讨p16INK4a在宫颈癌前病变及宫颈癌中的表达。方法:选取104例经活检证实的TCT阳性病例剩余标本,包括9例非典型鳞状细胞-意义不明(ASC-US)、54例低度鳞状上皮内病变(LSIL)、4例非典型鳞状细胞-不除外上皮内高度病变(ASC-H)、33例高度鳞状上皮内病变(HSIL)和4例鳞状上皮细胞癌(SCC),制作液基薄片进行p16INK4a免疫细胞化学检测,同时用基因杂交捕获法Ⅱ(HC-Ⅱ)检测高危人乳头瘤病毒(HR-HPV)DNA,探讨病毒负荷量与宫颈病变级别的关系。结果:p16INK4a在ASC-US、LSIL、ASC-H、HSIL和SCC中的表达率分别是22.2%、40.7%、50%、81.8%和100%。p16INK4a在ASC-US和HSIL之间、LSIL和HSIL之间表达有差异(P<0.003);结合组织学分析54例LSIL标本中p16INK4a阳性率,在炎症、CINⅠ、CINⅡ～Ⅲ中的阳性率分别是28.6%,25.0%和91.7%,CINⅡ～Ⅲ中p16INK4a的阳性率明显高于炎症组和CINⅠ组,3组之间的差异有显著统计学意义(P<0.001);HR-HPV DNA的荷载量与宫颈病变级别无相关性。结论:p16INK4a在液基细胞学HSIL中高表达,是细胞学诊断为LSIL病例中筛查癌前病变高危人群有意义的生物标记物。     

hTERC基因表达在宫颈病变诊治中的应用

目的:探讨宫颈脱落细胞中hTERC的基因表达在宫颈上皮内瘤样病变(CIN)诊断与治疗中的应用。方法:抽取行子宫颈癌筛查的724例妇女为研究对象,对其同步进行宫颈脱落细胞的液基细胞学检查、第二代杂交捕获技术(HC-Ⅱ)检测高危型HPV(HR-HPV)和荧光原位杂交(FISH)技术检测hTERC基因。对于细胞学为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)及以上病变,和(或)HR-HPV阳性者均行阴道镜下宫颈四象限多点活检进行病理诊断。结果:724例中经病理确定为CINⅠ,Ⅱ,Ⅲ及子宫颈癌者分别为251例(34.67%)、17例(2.35%)、48例(6.63%)和10例(1.38%),宫颈脱落细胞hTERC的扩增率为11.05%。①724例HPV阳性率为39.64%;hTERC扩增在HPV阳性与阴性组分别为19.86%与5.26%(χ2=37.556,P0.01)。②hTERC扩增在细胞学无宫颈上皮内瘤变(NILM)组为5.19%、ASCUS为10.23%、低度鳞状上皮内瘤样病变为(LSIL)11.84%、非典型鳞状上皮细胞-不除外高度鳞状上皮内瘤变(ASC-H)为21.43%、高度鳞状上皮内瘤样病变(HSIL)为73.17%、鳞状细胞癌(SCCA)为100.00%、非典型腺上皮细胞(AGC)为50.00%;hTERC在HSIL及以上病变中的扩增率明显高于LSIL及以下病变(χ2=186.755,P0.01)。③在不同组织学结果中hTERC的扩增率分别为,NILM 3.70%、CINⅠ4.38%、CINⅡ47.06%、CINⅢ58.33%、浸润癌90.00%,hTERC在CINⅡ及以上级别病变中的扩增率明显高于CINⅠ和NILM者(χ2=144.597,P0.01)。结论:hTERC的扩增与宫颈细胞学和组织学异常密切相关,hTERC扩增与否有可能作为判断有无高度病变及估计预后的指标之一。     

阴道镜检查在宫颈细胞学ASCUS分流管理中的应用

目的探讨电子阴道镜检查在宫颈细胞学意义未明的不典型鳞状细胞(atypical squamous cell of undeter-mined significance,ASCUS)分流管理中的临床应用价值。方法对2006年7月至2008年7月在天津医科大学第二医院门诊行宫颈液基细胞学检查(TCT)结果为ASCUS的471例患者进行电子阴道镜检查,其中203例阴道镜诊断为宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)及以上病变者在可疑病变区取活检送病理检查;268例阴道镜检查为正常或慢性宫颈炎者给予阴道用药治疗1~3个疗程,3个月后复查宫颈涂片,4例细胞学仍异常者行阴道镜下取活检送病理检查,余264例细胞学阴性者定期复查宫颈细胞学。结果471例宫颈细胞学AS-CUS患者中,共行活体组织病理学检查207例(43.95%),检出宫颈上皮内瘤样病变(CINⅠ~Ⅲ)131例,宫颈癌4例,余264例避免了宫颈活检损伤,随访6~30个月复查宫颈细胞学均未发现异常。结论电子阴道镜结合宫颈细胞学检查可有效检出宫颈细胞学ASCUS中CIN及宫颈癌患者,可作为基层医院对ASCUS进行有...     

薄层液基脱落细胞学在宫颈病变筛查中的应用

目的：探讨薄层液基细胞学技术在宫颈病变筛查中的临床实用价值。方法：对3696例宫颈病例进行液基细胞病理学检查，诊断标准采用TBS分类系统。结果：将分类结果为意义不明的非典型鳞状上皮以上病例分为阳性病例，3696例病例中阳性病例321例，阳性检出率8．8％，其中HSIL18例（0．5％），LSIL30例（0．8％），ASC—H24例（0．7％），AS—CUS 200例（5．4％），非典型腺细胞3例，提示HPV感染49例（1．3％）。结论：液基细胞学检查能正确反映宫颈病变情况，用于检查宫颈，可早期发现宫颈癌变及宫颈癌前病变，有效防止宫颈癌的发生，具有重要的临床实用价值。     

TCT在宫颈病变筛查中的临床价值及不足

目的通过与病理组织学比较，评价液基细胞学（TCT）在宫颈病变诊断中的临床价值与不足。方法选取2004年8月-2006年10月中国人民解放军总医院妇产科行液基细胞学检查的766例患者，在电子阴道镜下取宫颈活组织进行病理组织学检查。结果TCT与病理组织学的符合率在低度鳞状上皮内病变（LSIL）中为12．07％（21／174），高度鳞状上皮内病变（HSIL）符合率58．82％（50／85），宫颈癌符合率为70％（7／10）。在348例ASC中，14．94％（52／348）为CINⅡ～Ⅲ，1．44％（5／348）为宫颈癌，在35例AGc中，11．43％（4／35）为CINⅡ～Ⅲ，2．86％（1／35）为宫颈癌。宫颈癌发病年龄呈现双峰现象，分别为30～39岁和≥45岁。结论作为宫颈病变的初筛方法，TCT存在一定的假阳性和假阴性率，结合阴道镜下活检后，能明显提高诊断的准确率，做到早期发现，早期治疗。     

利普液基细胞学制片用于宫颈细胞学诊断1560例分析

目的探讨利普液基细胞学制片技术（Liqui-PREP），结合Bethesda 2001报告用于宫颈细胞学检查的临床价值。方法2004-07—2005-10，吉林大学白求恩医学部第一医院采用利普液基细胞学制片技术（Liqui-PREP），结合Bethesda 2001报告对1560例患者进行宫颈细胞学筛查。不除外高度病变的不典型鳞状上皮细胞（ASC-H）以上异常者在阴道镜下取宫颈活组织行病理学检查。结果1560例患者取材均为满意涂片。检出异常结果有：不明确意义的不典型鳞状上皮细胞（ASC-US）18例，不除外高度病变的不典型鳞状上皮细胞（ASC-H）10例，低度鳞状上皮内病变（LSIL）34例，高度鳞状上皮内病变（HSIL）20例，宫颈鳞癌4例，病理符合率为95．3％。结论利普液基细胞学制片技术用于妇科细胞学筛查，是一种行之有效的筛查方法。     

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。     

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。     

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.     

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.     

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。