宫颈冷刀锥切术诊治宫颈上皮内瘤变的价值

[目的]探讨宫颈冷刀锥切术对宫颈上皮内瘤变(CIN)的诊断及治疗作用.[方法]对比126例行宫颈冷刀锥切术和阴道镜下多点活检的CIN患者的病理检查结果,分析CIN患者行宫颈冷刀锥切术的临床疗效和并发症.[结果]阴道镜下多点活检和宫颈冷刀锥切术后病理完全符合83例(占65.9％).14例(11.1％)患者锥切边缘受累;发现早期浸润癌5例,其中2例早期浸润癌仅行宫颈锥切,随访无复发.宫颈冷刀锥切术的主要并发症为出血和宫颈管狭窄,发生率分别为6.3％ (8/126)和3.9％ (5/126).[结论]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.     

不同方法对宫颈上皮内瘤样病变Ⅲ级和宫颈癌的诊断价值对比

目的 观察阴道镜多点活检与宫颈冷刀锥切术在诊断宫颈上皮内瘤样病变(GIN)Ⅲ级以及早期宫颈癌中的诊断价值.方法 经阴道镜活检病理诊断为CIN或早期宫颈癌的患者共112例,所有患者均于LEEP下行宫颈锥切术,术后将组织送检进行组织病理学检查,分析结果与阴道镜多点活检的差异.结果 以宫颈冷刀锥切术为准,CIN Ⅰ级患者23例,CINⅡ级患者38例,CINⅢ级患者34例,原位癌患者11例,浸润癌患者6例.对比阴道镜多点活检病理结果,发现结果相符合67例,不符合45例.其中,诊断不足有21例,诊断过度有24例.112例患者中,经诊断为宫颈浸润癌者11例,阴道镜多点活检漏诊率8.6％;宫颈冷刀锥切术的术中出血量、出血时间等指标显著低于阴道镜多点活检术,差异有统计学意义(P＜0.05);宫颈冷刀锥切术出现术中出血、术后出血、术后子宫粘连等并发症发生率显著低于阴道镜多点活检法,差异有统计学意义(P＜0.05).结论 阴道镜多点活检在诊断CIN特别是CINⅢ级时存在较大的局限性,而通过联合宫颈冷刀锥切能够提高早期宫颈癌患者诊断的准确率,从而有效避免了隐匿性宫颈癌的临床漏诊,可以作为对宫颈癌进一步诊断提供重要的参考依据.     

妊娠期宫颈上皮内瘤样病变的筛查及治疗

综述了妊娠期宫颈上皮内瘤样病变的筛查方法 ,强调保守性治疗 ,反复阴道镜检查及镜下活检是安全可靠的 ,追加醋酸白试验可增加过度诊断 ,但敏感性可大大提高。如果阴道镜检查排除宫颈浸润癌 ,妇产科医生可将治疗时间推迟至产后 ,母婴危险性将降低。LEEP(loopelectrosurgicalexcision)治疗及宫颈锥切只应有于病理或阴道镜检查高度可疑癌或已证实为癌症的孕妇。妊娠期CIN转归率较高 ,但必须严密随访。     

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.     

妊娠期宫颈上皮内瘤样病变的筛查及治疗

综述了妊娠期宫颈上皮内瘤样病变的筛查方法，强调保守性治疗，反复阴道镜检查及镜下活检是安全可靠的，追加醋酸白试验可增加过度诊断，但敏感性可大大提高，如果阴道镜检查排除宫颈浸润癌，妇产科医生可将治疗时间推迟至产后，母婴危险性将降低。LEEP（loop electrosurgical excision)治疗及宫颈锥切只应有于病理或阴道镜检查高度可疑癌或已证实为部症的孕妇，妊娠期CIN转归率较高，但必须严密随访。     

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。     

宫颈冷刀锥切术95例临床分析

目的 比较宫颈活检结果与宫颈冷刀锥切术后病检结果的差异,评价宫颈多点活检在CIN 诊断中的准确性和宫颈冷刀锥切术的诊治价值,并分析锥切术近期并发症.方法 回顾性分析2009年-2010年因宫颈病变行阴道镜下多点活检及宫颈冷刀锥切术者95例,采用自身对照法,比较宫颈锥切术和阴道镜下多点活检的病理检查结果.结果:宫颈冷刀锥切术后病理与阴道镜下多点活检的病理检查结果符合者54例(56.84%),不符合者41例(43.16%),其中,冷刀锥切术后结果升级者11 例,占不符合例数的26.83%,占总例数的11.58% ;病变降级者30例,占不符合例数的73.17%,占总例数的31.58%.术中出血平均67.5ml,手术时间平均30.8分钟,术后出血6例(6.32%),术后发热1例.结论 宫颈冷刀锥切可补充多点活检的局限性,提高诊断准确性.     

宫颈冷刀锥切术95例临床分析

目的：比较宫颈活检结果与宫颈冷刀锥切术后病检结果的差异,评价宫颈多点活检在CIN诊断中的准确性和宫颈冷刀锥切术的诊治价值,并分析锥切术近期并发症。方法：回顾性分析2009年-2010年因宫颈病变行阴道镜下多点活检及宫颈冷刀锥切术者95例,采用自身对照法,比较宫颈锥切术和阴道镜下多点活检的病理检查结果。结果 ：宫颈冷刀锥切术后病理与阴道镜下多点活检的病理检查结果符合者54例（56.84%）,不符合者41例（43.16%）,其中,冷刀锥切术后结果升级者11例,占不符合例数的26.83%,占总例数的11.58%;病变降级者30例,占不符合例数的73.17%,占总例数的31.58%。术中出血平均67.5ml,手术时间平均30.8分钟,术后出血6例（6.32%）,术后发热1例。结论：宫颈冷刀锥切可补充多点活检的局限性,提高诊断准确性。     

LEEP术后病理检查与阴道镜宫颈活检对宫颈癌前病变的诊断准确性

目的通过比较LEEP术后病理检查和阴道镜宫颈活检对宫颈癌前病变诊断结果的差异,评价阴道镜宫颈活检诊断宫颈癌前病变的准确性。方法对315例行妇科检查的患者行阴道镜宫颈活检和LEEP手术以及术后病理组织检查。结果阴道镜下宫颈活检与LEEP术后组织病理诊断的总符合率为57.15%(180/315),诊断不足20.95%(66/315),诊断过度21.90%(69/315);CINⅠ级诊断符合率为76.67%(23/30),漏诊CINⅡ/CINⅢ级2例,无原位癌和微小浸润癌漏诊。CINⅡ/CINⅢ级(含原位癌)符合率为56.67%(63/111),漏诊浸润癌33例(33/111)。相关因素对比分析发现,阴道镜活检结果为高级别CIN和细胞学检查结果为HSIL及以上,是阴道镜宫颈活检浸润癌漏诊的危险因素(P<0.05)。结论阴道镜宫颈组织活检存在漏诊宫颈微小浸润癌的风险。阴道镜宫颈组织活检对象如果为高级别CIN患者,则应行LEEP术以达到进一步确诊或排除浸润癌的目的。     

G3BP和TIP30基因表达与子宫颈癌细胞转移潜能相关性的初步研究

目的：检测肿瘤转移基因G3BP和肿瘤转移抑制基因TIP30在正常子宫颈组织及子宫颈癌组织中的表达水平,探讨两者对子宫颈癌细胞转移潜能的影响。方法：选取2010—2011年我院妇检及行宫颈癌根治术的患者90例。采用Taqman探针实时荧光定量逆转录聚合酶链反应（RT—PcR）方法,检测正常子宫颈组织（30例）、子宫颈浸润癌（均为子宫颈鳞状细胞癌）未转移组及转移组组织（各30例）中G3BP、TIP30基因表达情况,并对其进行比较分析。结果：1）G3BP基因在子宫颈癌转移组中的表达水平（0．088±0．081）显著高于未转移组（0．006±0．003）及正常子宫颈组织（0．000±0．000）,P值均〈0．001;子宫颈癌未转移组的表达水平高于正常子宫颈组,差异有统计学意义,P〈0．001。2）TIP30基因在子宫颈癌转移组中的表达水平（0．000±0．000）显著低于未转移组（0．001±0．000）及正常子宫颈组织（0．012±0．001）,P值均〈0．001,子宫颈癌未转移组的表达水平低于正常子宫颈组,差异有统计学意义,P〈0．001。结论：G3BP在正常子宫颈组织、子宫颈癌未转移组及转移组中呈升序表达,而TIP30基因则呈降序表达,G3BP和TIP30基因在子宫颈癌细胞的转移中发挥一定作用,从而影响子宫颈癌的发生、发展。     

DNA定量分析用于宫颈癌及癌前病变的早期筛查探讨

[目的]探讨用DNA定量分析和常规细胞学相结合方法而诊断宫颈癌及癌前病变。[方法]对3266名妇女用宫颈刷取材,每例液基薄层制片2张,1张巴氏染色做常规细胞学检查,1张Feulgan DNA染色用全自动DNA倍体分析系统做DNA定量测定。常规细胞学和DNA倍体分析系统可疑的妇女在阴道镜下行宫颈组织学活检。[结果]3266例宫颈癌标本中,常规细胞学发现42例非典型鳞状上皮（ASCUS）,9例低级别鳞状上皮内病变（LSIL）及1例高级别鳞状上皮内病变（HSIL）。DNA倍体分析发现3个或3个以上〉5C细胞的35例。32例活检病例中有14例宫颈上皮内瘤变2（CIN2）或CIN2以上级别改变,这14例细胞标本中均可见DNA倍体异常,而常规细胞学发现1例正常,8例ASCUS,4例LSIL和1例HSIL。[结论]DNA倍体分析与常规细胞学相结合方法可提高宫颈癌及癌前病变的阳性率。     

妊娠期生理特点与宫颈癌的关系及围妊娠期宫颈癌筛查的意义

目的 探讨妊娠期生理特点与宫颈癌的关系及加强宫颈疾病史妇女围妊娠期宫颈癌筛查的意义.方法 选取2018年1月至2020年1月间陕西省西安医学院第二附属医院妇产科门诊建立档案并接受正规产前检查的22141例孕妇作为研究对象,根据是否处于妊娠期进行分组,妊娠期3328例,非妊娠期18813例.按照自愿原则,受检者接受液基细...     

宫颈癌活检病理与术后石蜡病理的符合率及意义

目的:探讨宫颈癌术前阴道镜下宫颈活检病理与子宫全切或广切术后石蜡病理的符合率及其临床意义.方法:回顾性分析2012年1月-2015年5月就诊于中国医科大学附属盛京医院妇科行手术治疗的1 872例宫颈恶性肿瘤患者的临床病理资料.对符合纳入标准的1 818例患者进行统计研究.结果:1 818例患者中,宫颈鳞状细胞癌1 575例,宫颈腺癌173例,宫颈腺鳞癌53例,其他病理类型17例.1 818例患者中,宫颈活检病理与子宫全切或广切术后石蜡病理结果相符合的为1 487例,总符合率为81.8%.其中816例直接于我院行宫颈活检及病理组织检查,1 002例于外院行宫颈活检后于我院行病理切片会诊,我院宫颈活检病理诊断符合率为83.8%,外院为80.1%,差异有统计学意义.我院宫颈鳞癌、腺癌、腺鳞癌及其他少见病理类型诊断符合率为86.7%、75.3%、40.7%、70.0%;外院宫颈鳞癌、腺癌、腺鳞癌及其他少见病理类型诊断符合率为82.0%、80.4%、26.9%、42.9%,宫颈鳞癌诊断符合率两者之间差异有统计学意义.外院与我院高-中分化组宫颈癌的活检病理诊断符合率均明显高于低分化组,差异有统计学意义.原位癌-Ia1期宫颈癌的宫颈活检病理诊断符合率均明显低于Ia2期-IIb期,差异有统计学意义.结论:阴道镜下宫颈活检有漏诊宫颈癌的可能,尤其是原位癌-Ia1期宫颈癌;完善上级医院病理会诊可提高术前诊断的准确性,对于临床上治疗方案的选择具有重要价值.     

Pregnancy-related complications after vaginal radical trachelectomy for early-stage invasive uterine cervical cancer

Background Pregnancy-related complications after vaginal radical trachelectomy (RT) for early-stage invasive uterine cervical cancer were studied in comparison with those occurring after laser conization. The strategy to reduce vaginal RT-related complications during pregnancy is also discussed. Methods Pregnancy courses after vaginal RT in two patients and those after laser conization in five patients, whose operations were performed during the same period, were studied with respect to symptoms, cervical length, and infectious signs. Results The cervix shortened progressively both in patients with laser conization and in those with RT. However, throughout the pregnancy, the remaining cervix after the operation was longer in patients who had undergone conization than in those who had undergone vaginal RT. After laser conization, two of the five patients suffered from preterm rupture of the membrane (PROM) at 36 weeks of gestation, and both patients who had undergone vaginal RT had premature PROM (pPROM), at 32 and 24 weeks of gestation, respectively. Conclusion Prevention of preterm labor and the following occurrence of pPROM is a significant task to be resolved in order to improve pregnancy outcome after vaginal RT for early-stage invasive uterine cervical cancer. Daily vaginal disinfection with povidone iodine and the administration of a ulinastatin vaginal suppository, bed rest, and the use of ritodrine would be the best approach, and a more conservative approach for stage Ia2 also might be taken into consideration.     

高级别宫颈上皮内瘤变行子宫切除术患者术前病理确诊方式的回顾性分析

目的:通过对比阴道镜下活检病理、宫颈锥切术中冰冻病理与术后石蜡病理（paraffin section examination,PSE）的一致性,对高级别宫颈上皮内瘤变行子宫切除术的术前病理确诊方式进行研究。方法:选取2010年1月至2015年12月阴道镜活检病理为宫颈上皮内瘤变Ⅱ级(CINⅡ)和Ⅲ级(CINⅢ、原位癌)在我院行宫颈锥切术患者共454例,其中依宫颈锥切术中冰冻病理即刻行子宫切除手术治疗患者238例,另外216例为待宫颈锥切术后石蜡病理回报后再次子宫切除手术治疗的患者,对比阴道镜下活检病理、宫颈锥切术中冰冻病理与术后石蜡病理的一致性,以及对比锥切术后石蜡病理与再次子宫切除术后病理的一致性。结果:阴道镜活检与术中冰冻病理诊断的符合率为89.11%（270/303）,CINⅡ为63.33％（38/60）,22例升级为CINⅢ;CINⅢ为95.47%（232/243）,11例升级（9例升级为宫颈癌Ⅰa1期,2例升级为Ⅰb1期）。阴道镜活检与术后石蜡病理诊断的符合率为77.53%(352/454)。CINⅡ为22.99%(20/87),67例升级（57例升级为CINⅢ,8例升级为宫颈癌Ⅰa1期,2例升级为Ⅰa2期）;CINⅢ为 90.46%（332/367）,35例升级（26例升级为宫颈癌Ⅰa1期,7例升级为Ⅰb1期,2例升级为Ⅱa期）。阴道镜活检对宫颈癌的漏诊率总体为9.91％(45／454)。宫颈锥切术中同时送冰冻病理患者303例,宫颈锥切术中冰冻病理与术后石蜡病理诊断的符合率为88.12%(267/303)。CINⅡ为60.00%(36/60),24例升级（18例升级为CINⅢ,5例升级为宫颈癌Ⅰa1期,1例升级为Ⅰa2期）;CINⅢ为95.06%(231/243),12例升级（9例升级为宫颈癌Ⅰa1期,2例升级为Ⅰb1期,1例升级为Ⅱa期）。宫颈锥切术中冰冻病理对宫颈癌的漏诊率总体为5.94%（18/303）。宫颈锥切术中同时送冰冻病理患者303例,宫颈锥切术术中冰冻病理比阴道镜活检病理诊断的符合率高,差异有统计学意义（χ2= 27.68,P﹤0.05）。待宫颈锥切术后石蜡病理回报后再次手术治疗的216例患者中,宫颈锥切术后石蜡病理对高级别宫颈上皮内瘤变及浸润癌诊断的准确率可达99.07％（214/216）。结论:阴道镜活检是初步诊断高级别宫颈上皮内瘤变的一种方法;宫颈锥切术具有诊断与治疗的作用,术中冰冻病理（frozen section examination,FSE）能够提早发现部分微小浸润癌及浸润癌,但是存在一定的误诊和漏诊率。因此,建议对所有无生育要求的高级别宫颈上皮内瘤变患者,应先行宫颈锥切术,待术后石蜡病理回报后再行子宫切除术,以达到规范治疗。     

Chemoprevention of cancer of the uterine cervix--preliminary study on the intervention of the cervical precancerous lesion by retinamide RII

Twenty seven women with mild, moderate or severe cervical dysplasia proven by pathology were treated by retinamide RII suppository. Retinamide RII suppository, 10 mg QD, was given intravaginally for six months (three months as a course). Clinical examination, Papanicolaou cytology and tissue biopsy under colposcope were carried out before and after treatment. The results indicated that after the second course, 26 out of 27 patients responded; of them, precancerous lesions disappeared in 24 and even normal squamous epithelium was observed in 3. The overall response rate was 96.29% and the marked response rate was 88.89%. The general side effects were mild. There was little cervical and vaginal irritation which was well tolerated. The results of this clinical trial make available a practical base for chemoprevention of cervical cancer.     

Two-dimensional electrophoresis analysis of differential protein expression in squamous carcinoma of the cervix

Objective： To establish and optimize the two-dimensional gel electrophoresis （2-DE） maps of squamous carcinoma of the cervix and to study the protein difference between squamous carcinoma of the cervix （SCC） and normal cervical tissue. Methods： Using Two-dimensional gel electrophoresis followed by computer-assisted image analysis, the differential proteins between squamous carcinoma of the cervical tissue and normal cervical tissue were compared. Then using matrix-assisted laser desorption/ionization-time of flight mass spectrometry, the differential proteins were identified. Results： The well-resolved and reproducible two-dimensional gel electrophoresis patterns of squamous carcinoma of the cervix tissue and normal cervical tissue were obtained. After silver staining, the average matching ratio of squamous carcinoma of the cervix was 86.1%. There was a good reproducibility of spot position in 2-DE map, with average deviation in IEF direction of 0.95±0.13 mm, while in SDS-PAGE direction it was 1.20±0.18 mm. Ten protein spots were identified by mass spectrometry, some of which were involved in cell proliferation, cell apoptosis, intracellular enzymes, structural proteins, cycle regulation, and tumor occurrence. Conclusion： The differentially expressed proteins provide a fundamental basis for further study of human squamous carcinoma of the cervix and screening of its specific markers.     

Extent of treatment of early carcinoma of the uterine cervix--local treatment of 198 stage I patients

The extent of treatment of early carcinoma of the uterine cervix is still controversial. 198 patients with Stage I carcinoma of the uterine cervix who received local treatment for the primary tumor are summarized, 107 with early invasive carcinoma and 91 with invasive cancer. Microscopic examination showed that 62.2% of the patients had lesions less than 1 cm in diameter. In 82.8% of the patients, the invasion was confined to the cervical ring by pathological examination. The accuracy of multiple biopsies was 79.3%. Of 198 patients, 124 received intracavitary radiotherapy only, 73 hysterectomy and 1 cone resection of the uterine cervix. All of them were followed for 5 years or more. The 5-year survival rate was 98% and none of them died of cancer. The author considers that the extent of treatment of early invasive carcinoma can be localized. For localized invasive carcinoma (stage Ib) with lesion less than 1 cm and extent of invasion less than half of the uterine cervix ring as confirmed by biopsy, the treatment of regional lymph nodes can be omitted. Multiple biopsies may replace diagnostic cone resection in most instances.     

冰冻病理检查诊断宫颈上皮内瘤变Ⅲ级和评估锥切组织边缘状态的作用

目的 探讨冰冻病理检查方法用于诊断宫颈上皮内瘤变Ⅲ级(CINⅢ)和评估锥切组织边缘状态的作用.方法 对36例宫颈上皮内瘤变Ⅲ级患者(CINⅢ),进行宫颈锥切术或者子宫切除术,采用冰冻病理检查方法对患者的锥切标本进行诊断,术中对保留的宫颈取材组织行切片检查,分析并比较冰冻病理与石蜡病理检查的结果,同时评估锥切组织边缘状态,考察组织切缘病灶残留情况.结果 ①所有病患术中冰冻病理检查诊断结果:2例宫颈浸润癌,29例CINⅢ,3例CINⅡ,2例CINⅠ.术后石蜡病理检查诊断结果:30例CINⅢ,2例CINⅡ,2例CINⅠ以及2例宫颈浸润癌.②锥切标本、锥切后宫颈取材组织的冰冻病理检查和术后宫颈石蜡病理检查结果均提示3例患者锥切组织边缘状态为阳性,接受子宫切除术以后显示有残留病灶.33例患者锥切组织边缘状态为阴性,接受子宫切除术以后均显示无残留病灶.结论 冰冻病理检查能有效诊断CINⅢ,并能够准确评估锥切组织边缘状态是否还有残留病灶.