宫颈锥切术在诊断宫颈病变中的价值分析

目的:探讨宫颈锥切术能否被阴道镜多点活检所代替以及宫颈锥切术在诊断宫颈上皮内瘤样病变(CIN)和早期宫颈癌中的价值。方法:回顾分析2007年1月-12月在江西省妇幼保健院肿瘤科因宫颈病变同时行阴道镜多点活检和宫颈锥切术(包括冷刀和电圈环切术即LEEP术)的患者120例,采用自身对照法,研究宫颈锥切术和阴道镜多点活检的病检结果的差异。结果:宫颈锥切术与阴道镜下多点活检病理符合者59例(49.17%);不符合者61例(50.83%),宫颈锥切术后病理诊断加重者35例(占29.17%),浸润癌漏诊率10.00%。结论:宫颈锥切术在诊断C IN和早期宫颈癌中具有重要价值,不能被阴道镜多点活检所取代。要重视切缘是否阳性并加强术后随访。     

宫颈锥切对宫颈上皮内瘤样病变及早期浸润癌诊断价值的探讨

宫颈锥切是治疗宫颈疾病的1种主要方法,但是宫颈锥切作为宫颈上皮内瘤样病变(ｃｅｒｖｉｃａｌｉｎｔｒａｅｐｉｔｈｅｌｉａｌｎｅｏｐｌａｓｉａ,ＣＩＮ)及宫颈早期浸润癌(下简称早浸癌)的诊断方法,与宫颈细胞学检查及宫颈点式活检相比较,其诊断价值,学者们的评价不一[4,6～8     

宫颈锥切术后HPV检测的临床意义

目的:探讨人乳头瘤病毒(HPV)在宫颈上皮内瘤样病变(CIN)行LEEP、冷刀锥切(CKC)术后的随访价值。方法:回顾分析180例行LEEP锥切、119例行冷刀锥切的CIN患者术前、术后HPV感染情况,观察锥切术后CIN的消失情况。结果:二者手术前后HPV感染率分别为:LEEP组78.3%和7.8%,CKC组64.7%和6.7%,无统计学差异,术后HPV感染率明显降低,术后HPV持续感染者宫颈病变进展率高于HPV转阴者,二者有统计学差异。结论:HPV检测在LE EP、CKC术后可作为随访有效手段。     

宫颈锥切术后HPV检测的临床意义

目的：探讨人乳头瘤病毒（HPV）在宫颈上皮内瘤样病变（CIN）行LEEP、冷刀锥切（CKC）术后的随访价值。方法：回顾分析180例行LEEP锥切、119例行冷刀锥切的CIN患者术前、术后HPV感染情况,观察锥切术后CIN的消失情况。结果：二者手术前后HPV感染率分别为：LEEP组78.3%和7.8%,CKC组64.7%和6.7%,无统计学差异,术后HPV感染率明显降低,术后HPV持续感染者宫颈病变进展率高于HPV转阴者,二者有统计学差异。结论：HPV检测在LE EP、CKC术后可作为随访有效手段。     

冷刀宫颈锥切术诊治宫颈上皮内瘤变的临床体会

为了探讨冷刀宫颈锥切术对宫颈上皮内瘤变的诊断治疗作用,并评价临床疗效,回顾性分析因宫颈病变行宫颈细胞学检查、阴道镜下多点活检和宫颈锥切术的患者186例,对比宫颈锥切术和阴道镜下多点活检的病理检查结果,分析冷刀宫颈锥切术的临床疗效和并发症.两者病理完全符合138例,占74.2%,不符合48例,占25.8%.8例(4.3%)患者锥切边缘受累,治愈率为98.9%,复发率为1.1%.发现早期浸润癌5例,其中2例仅行宫颈锥切随访无复发.11例患者后行子宫切除术或扩大子宫切除术.冷刀宫颈锥切术的主要并发症为出血和宫颈管狭窄,发生率分别为4.3%(8/186)和1.6%(3/186).初步研究结果提示,宫颈锥切术比阴道镜下多点活检对宫颈上皮内瘤变的诊断更准确,并具有重要治疗作用.     

HPV-DNA检测在宫颈病变诊断中的价值

背景与目的：宫颈癌是妇女常见的恶性肿瘤之一。目前大量的研究认为HPV是宫颈癌的主要致病因素，几乎所有CIN都伴有HPV亚型。本研究旨在评价HPV—DNA检测对宫颈病变的诊断价值。方法：对320例HPV—DNA检测患者在宫颈病变检查方面的资料进行分析。结果：①HPV—DNA高危型阳性患者无明显临床症状，妇科检查以宫颈糜烂为主要表现，②CIN发病率在HPV—DNA高危型阳性组30％，阴性组11％（P〈0．01），③HPV—DNA高危型阳性的CIN患者中17％是高度病变（CIN—Ⅱ及以上），阴性组仅2％（P〈0．05）④随细胞学检查的级别增高，HPV—DNA高危型阳性率增加（P〈0．05），HPV感染发生率增加（P〈0．01），CIN发生率增加（P〈0．05）。结论：HP—DNA高危型患者CIN发病率较高，CIN高度病变比例较高，HPV-DNA检测在宫颈病变的检查中有重要意义；如与宫颈细胞学检查和阴道镜检查结合可提高宫颈病变的检出率。     

宫颈冷刀锥切术在宫颈上皮内瘤变诊治中的评价

背景与目的：宫颈冷刀锥切术(cold knife conization,CKC)是一种经典的诊治方法,本研究取62例宫颈锥切标本,分析宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的组织学特点,探讨CKC在CIN诊断治疗中的临床意义。方法：对比分析62例行CKC的CIN患者病理标本与术前多点活检的病理所见。结果：CKC与术前多点活检结果完全符合者有44例(71％);有差异者18例(29％),其中4例术前多点活检为CIN2和CIN3,而锥切为CIN3和微小早期浸润癌。62例均为鳞状上皮病变,其中34例为CIN3或以上,病变主要位于移行区,常累及宫颈管,30例(88．2％)同时累及≥2个象限,37例(59．7％)有HPV感染,31例(50％)鳞状上皮化生,8例伴不同程度的非典型增生。切缘病变残留率分别是3．2％(≥CIN2)和8．1％(CIN1),低于文献报道的宫颈环形电切(loop electrosurgieal excision,procedure)的残留率。56例患者随访4个月--14年。均无复发,3例术后妊娠分娩。结论：宫颈锥切在宫颈CIN的诊治中仍有其优势。     

宫颈锥切术后病变残留的危险因素分析

目的：探讨宫颈高级别鳞状上皮内病变（high grade squamous intraepithelial，HSIL）行宫颈锥切术后切缘阳性患者，出现病变残留的预测因素。方法：对我院2018年6月至2018年12月因HSIL锥切手术，因切缘阳性接受二次手术的80例患者进行横断面研究，采用单因素及多因素Logistic回归模型，分析患者年龄、生育情况、绝经状态、吸烟与否、高危型人乳头瘤病毒（high-risk human papillomavirus，HR-HPV）感染型别、宫颈液基细胞学检查结果、颈管搔刮结果、转化区类型、病变是否累及腺体、病变范围（累及象限）、圆锥周长、圆锥长度、阳性切缘位置等因素与宫颈锥切术后病变残留的相关性。结果：单因素分析显示宫颈HSIL患者锥切术后病变残留与绝经状态（P＝0.025）、HR HPV感染型别（P＝0.011）、转化区类型（P＝0.005）、圆锥长度（P＜0.001）相关；多因素回归分析提示圆锥长度（OR＝0.21，CI0.071～0.633）和转化区类型（OR＝2.394 CI3.198～4.100）是病变残留的独立危险因素。结论：转化区类型和锥长是锥切术后病变残留的独立危险因素。     

宫颈上皮瘤样病变LEEP锥切术后HPV感染的动态监测分析

目的探讨宫颈上皮瘤样病变患者(CIN)经过LEEP锥切术后HPV感染的变化情况。方法将309例经阴道镜下活检确诊为CIN患者,按照组织病理学诊断分为CINⅠ组、CINⅡ组、CINⅢ组,分别观察三组患者LEEP术前与术后HPV感染的差异及术后3、6、9、12个月HPV感染的差异。结果三组患者术前镜检与术后标本检查HPV感染情况基本一致,三组组内比较差异无统计学意义(P>0.05),CINⅢ组HPV感染阳性率明显高于CINⅡ、CINⅠ组,三组间比较差异均具有统计学意义(P<0.05);三组HPV感染率术后3、6、9、12个月与术前比较均明显降低,且差异具有统计学意义(P<0.05),三组术后3、6、9、12个月组间比较差异具有统计学意义(P<0.05),CINⅠ组术后HPV残存率明显低于CINⅡ组和CINⅢ组,CINⅡ组明显低于CINⅢ组;三组术后12个月转阴率分别为CINⅠ(98.94%)、CINⅡ(92.95%)、CINⅢ(86.44%),三组之间两两比较差异具有统计学意义(P<0.05)。结论 CIN病理级别越低HPV感染率越低,术后HPV残存率和复发率均明显低于CIN病理级别高者。     

宫颈电刀锥切术诊治宫颈病变133例分析

[目的]探讨宫颈电刀锥切术在诊治宫颈上皮内瘤变（CIN）及早期浸润癌中的临床价值。[方法]回顾性分析133例宫颈病变患者的术后病灶残留、手术前后诊断符合情况及再次治疗情况。[结果]锥切前宫颈活检诊断的准确率为84.21％（112／133）。4例（4／133）患者锥切标本切缘阳性．包括2例原位癌与2例浸润癌，再行子宫切除的标本中，除了1例原位癌以外，其余3例都有残留病灶。锥切术后标本中切缘阴性的129例病例中，9例（包括3例宫颈原位癌、5例Ⅰa1期与1例Ⅰa，期宫颈癌）再行子宫切除术，有1例原位癌和2例Ⅰa，期宫颈早期浸润癌有残留病灶。[结论]宫颈锥切可明确宫颈病变的诊断，避免过度治疗或治疗不足；尽管宫颈锥切已达到CIN与Ⅰa1期宫颈癌的治疗范同，但部分患者宜进一步处理。     

Clearance of human papillomavirus infection after successful conization in patients with cervical intraepithelial neoplasia

The natural history of high‐risk human papillomavirus (HRHPV) infection after successful treatment of cervical intraepithelial neoplasia (CIN) is not well known. This study was performed to evaluate the rate and pattern of HRHPV infection clearance after successful conization for CIN and to analyze factors associated with such clearance. A total of 287 patients who underwent loop electrosurgical excision procedures (LEEP) owing to HRHPV‐associated CIN were included. All patients had negative resection margins on LEEP specimens and underwent HPV testing with the hybrid capture II system at 3‐, 6‐, 9‐, 12‐, 18‐ and 24‐month follow‐up visits after LEEP. Persistent HPV infections were detected in 45.6%, 14.3%, 6.3%, 2.2%, 1.5% and 1.1% of patients at 3, 6, 9, 12, 18 and 24 months after LEEP, respectively. Clearance rates did not differ by age, parity or severity of cervical lesion. However, clearance rates were significantly slower in patients with HPV DNA loads >500 RLU/PC before LEEP (p = 0.040). During 2 years of follow‐up after LEEP, 24 patients had recurrent disease revealed by biopsy. The odds ratios for recurrent disease in patients with persistent HRHPV infection increased gradually from 5.17 at the 3‐month follow‐up visit to 12.54, 15.69 and 25.90 at 6‐, 9‐, 12‐ and 24‐month follow‐up visits, respectively. We conclude that HRHPV infection cleared gradually in most patients within 6 months of treatment. Clearance rates were significantly slower in patients with HPV DNA loads >500 RLU/PC. Persistent HPV infection was a significant positive predictor of recurrence.     

应用普通电刀的宫颈锥切术诊治宫颈上皮内瘤变和微小浸润癌的临床观察

背景与目的：高频电波刀电圈切除术和宫颈冷刀锥切术已经广泛应用于宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）的诊治中。本研究旨在探讨普通电刀的宫颈锥切术在CIN和微小浸润癌的诊治中的临床应用价值。方法：回顾性分析2004年4月至2006年7月间在我院接受普通电刀的宫颈锥切术的173例患者的临床病理资料。记录手术时间、手术出血量，分析术后病灶残留、手术前后病理符合情况及再次手术情况。结果：173例患者平均年龄37．2岁（23～63岁），绝经3例，未生育者5例。手术中位时间为5min，中位出血量为5ml。锥切标本的病理诊断较阴道镜下活检或宫颈多点活检有降级或升级，各级别病变中手术前后的病理符合率为61．3％（25．0％～72．4％）。在163例术前诊为CIN的患者中，共发现9例微小浸润癌ⅠA1期，3例ⅠA2期。8例术前诊为微小浸润癌ⅠA1期中，3例间质浸润深度超过微小浸润癌范围被诊为局部早期浸润癌ⅠB1期。最后诊为ⅠA1期的14例患者中，1例切缘阳性者再次行锥切术，另有5例行次广泛全子宫切除术。所有ⅠA2期患者和ⅠB1期患者术后接受宫颈癌根治术。最后诊为CIN的151例患者中，3例切缘阳性，其中1例补充行全子宫切除术。2例术前活检阴性者锥切术后被证实为浸润性腺癌，另有3例CIN患者同时合并原位腺癌，术后均予再次手术。结论：应用普通电刀的宫颈锥切术是一种设备简单、手术时间短、出血少，且切净率高的诊治CIN和微小浸润癌的方法。其对宫颈微小浸润癌、局部早期浸润癌和腺癌的诊断率高。锥切术后为早期浸润癌或切缘阳性者，应根据具体情况进一步处理。     

关于子宫颈上皮内瘤变诊治问题的讨论

当前,宫颈癌依然是妇女健康的"头号杀手",高危持续性人乳头瘤病毒(HPV)感染是宫颈癌和子宫颈上皮内瘤变(CIN)发病的必要条件.CIN的发病率在我国尚无确切数据;在美国,CIN的发病率为3.8%.由于宫颈癌和CIN发病率的上升以及患者的年轻化,引起了学者们的广泛关注.国内外学术团体制定了一系列诊治指南,我国也相继出台了有关指南,其目的是为了规范宫颈癌和CIN临床的诊治,使患者得到合理的个体化治疗,但在CIN诊断程序标准化和治疗规范化中仍存在不少问题,值得进一步探讨.     

高危型人乳头瘤病毒检测对宫颈上皮内瘤样病变诊断价值的探讨

目的:探讨在ASC-H患者中检测HR-HPV DNA预测宫颈上皮内瘤样病变(CIN)和浸润癌的价值,为完善CIN和浸润癌的筛查方案提供依据.方法:研究宫颈薄层液基细胞学诊断为ASC-H的患者68例,均进行HR-HPV DNA检测并在阴道镜下行宫颈组织活检,综合评价HR-HPV预测高级别CIN的价值.结果:在ASC-H中CIN发生率为52.9％(36/68),CINⅡ及以上病变(CINⅡ、CINⅢ及浸润癌)发生率为33.8％(23/68); HR-HPV检测阳性率为70.6％(48/68),HR-HPV阳性组CINⅡ及以上病变发生率为47.9％(23/48),HR-HPV阴性组CINⅡ及以上病变发生率为0(0/20),两组比较差异有统计学意义,x2=14.797,P=0.001,HR-HPV诊断CINⅡ及以上病变的敏感度和特异度分别为100.0％和44.4％,阳性预测价值和阴性预测价值分别为47.9％和100.0％.结论:初步研究结果提示,HR-HPV阳性ASC-H患者应高度警惕CINⅡ及以上病变发生,建议立即行阴道镜检查;而HR-HPV阴性患者可不进行阴道镜检查.     

宫颈上皮内瘤变手术后边缘的评价

宫颈上皮内瘤变（cervical intraepithelial neoplasia．CIN）由Richart于1967年提出,根据Richart的定义,CINⅢ期包括宫颈的重度不典型增生和原位癌。目前对于评价和治疗CINⅢ期的指征很明确,但对于宫颈锥切术后切缘阳性患者的处理仍有争议。我们对2．51例CINⅢ期接受冷刀锥切术患者的切缘及相关因素进行了分析,现将结果报道如下。     

Long‐term risk of cervical cancer following conization of cervical intraepithelial neoplasia grade 3—A Danish nationwide cohort study

Using nationwide Danish registries we examined the long‐term risk of cervical cancer in women diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) (including adenocarcinoma in situ (AIS)) on the cone compared to women with a normal cytology test. Initially, we identified women born 1918–1990, who were recorded as living in Denmark between January 1, 1978 and December 31, 2012. From the Pathology Data Bank information on CIN3 on the cone, margins status, histological type of CIN3 and cervical cytology results was extracted. Cox proportional hazard model was used to estimate the relative risk of subsequent cervical cancer. We included 59,464 women with CIN3 on the cone and 1,918,508 women with a normal cytology test. Overall, women diagnosed with CIN3 had a higher risk of subsequent cervical cancer compared to women with normal cytology (HR = 2.06; 95%CI: 1.81–2.35). Analyses according to time since conization showed elevated risks in all time periods, and 25 years or more after conization the relative risk was significantly increased (HR = 2.56; 95%CI: 1.37–4.77). Twenty years or more after conization, also women with negative margins had an increased relative risk (HR = 2.49; 95%CI: 1.12–5.57). In addition, the long‐term relative risk of cervical cancer varied with the different histological types of CIN3 and was highest for AIS (HR = 7.50; 95%CI: 1.87–30.01, 10–14 years after conization). In conclusion, women diagnosed with CIN3 on the cone have a long‐lasting increased risk of cervical cancer even when the margins on the cone are negative.     

Human papillomavirus genotype in cervical intraepithelial neoplasia grades 2 and 3 of Taiwanese women

We aimed to assess the distribution of human papillomavirus (HPV) genotypes in high‐grade cervical lesions in Taiwan. The study included 1,086 paraffin‐embedded, formaldehyde‐fixed cervical intraepithelial neoplasia (CIN) 2/3 specimens. HPV genotyping was performed using polymerase chain reaction (PCR)‐based methods. Multiple HPV types were validated by E6 type‐specific PCR, direct sequencing and/or real‐time PCR. HPV DNA was detected in 995 (91.6%) specimens, and multiple HPV types were identified in 192 (19.3%) samples. The leading HPV types were HPV16 (24%), HPV52 (20%), HPV58 (20%), HPV33 (13%), HPV31 (8%) and HPV18 (4.6%). Although the leading six types consisted of 87.6%, HPV16 or 18 comprised only 30.9%. The prevalence of different HPV types showed a significant association with age. In women older than 50 yr, HPV16 and 18 comprised 21.3% (83/389), while HPV52, 58 and 33 represented 55.5% (216/389). In women aged less than 50 yr, HPV16 and 18 comprised 32.1% (224/697, p < 0.0001), while HPV 52, 58 and 33 represented 47.9% (334/697, p = 0.02). The distribution of HPV genotypes was compared with previously reported findings for Taiwanese women with cervical cancer (CC). The overall HPV16 positivity rate was significantly higher in CC than in CIN 2/3 (odds ratio: 2.14, 95% CI: 1.91–2.40). In addition, HPV18, 39 and 45 were significantly overrepresented in CC, whereas HPV52, 58, 33, 31, 35, 51 and 53 were underrepresented. We concluded that an effective vaccine against the most common HPV types could prevent a significant proportion of cervical cancer cases that occur in Taiwan.     

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。