子宫颈癌患者血清、盆腔淋巴结HPV检测及其相关性探讨

目的:检测宫颈癌患者原发灶、血清及其盆腔淋巴结中HPV DNA及亚型,探讨其相关性及临床意义。方法:选取16例行广泛全子宫切除术和盆腔淋巴结清扫术宫颈癌患者的原发灶组织、术前静脉血与盆腔淋巴结石蜡组织,运用PCR方法对上述标本进行HPV DNA及亚型的检测。结果:宫颈癌原发灶组织、血清标本中HPV DNA阳性率为50%(8/16)。16例盆腔淋巴结石蜡组织中13例为HPV DNA阳性(13/16,81.25%),其中总共切除的133个淋巴结中60个为阳性(60/133,45.1%),8例淋巴结HPV DNA阳性的病例其对应的原发灶组织也为阳性且两者亚型相同。盆腔淋巴结中的HPV DNA阳性率为45.1%(60/133),显著高于病理证实的淋巴结转移率1.5%(2/133)。6例患者(6/16,37.5%)原发灶、血清、盆腔淋巴结同时均为HPV DNA阳性;2例患者(2/16,12.5%)原发灶、盆腔淋巴结中HPV DNA表达阳性,而血清为阴性;1例患者(1/16,6.25%)淋巴结、血清HPV DNA阳性,而原发灶为阴性;未发现原发灶、血清HPV DNA表达阳性而淋巴结为阴性的病例,而且以上HPV DNA阳性的病例同一个患者对应的HPV亚型也相同。结论:宫颈癌患者血清中HPV DNA检出率与临床分期无关。宫颈癌患者盆腔淋巴结的HPV DNA检测可提高病理诊断淋巴结转移的阳性率,并且淋巴结中HPV DNA的检出率与原发灶的分化程度相关。宫颈癌原发灶、血清、盆腔淋巴结中HPV感染可能存在相关性。     

盆腔淋巴结清扫对评估膀胱癌预后的价值

目的:评价规范化盆腔淋巴结清扫对膀胱癌患者预后的影响作用,分析影响淋巴结转移的相关因素及淋巴结肿大与淋巴结转移两者的关系。方法:回顾性分析2008年1 月至2013年7 月天津医科大学肿瘤医院120 例膀胱癌患者临床资料,分为盆腔淋巴结规范化清扫组58例,未规范化清扫组62例。分析淋巴结转移与病理分期、分级及术中触及肿大淋巴结的关系,探讨盆腔淋巴结清扫对预后的影响。结果:120 例膀胱癌患者术后1、3、5 年总生存率分别为84.0% 、69.9% 、57.9% 。规范化盆腔淋巴结清扫组与未规范化清扫组的3 年生存率分别为78.4% 与46.2%（χ2= 5.487,P = 0.019）。 淋巴结阳性与阴性患者术后3 年生存率分别为50.0% 与86.4% ,（χ2= 9.303,P = 0.002）。 术中触及肿大淋巴结与淋巴结转移具有相关性（P < 0.001）,病理分期、病理类型（尿路上皮癌及非尿路上皮癌）及年龄是患者预后的影响因素（P < 0.05）。 结论:术中触及肿大淋巴结与淋巴结转移相关,可预测淋巴结转移的发生,盆腔淋巴结清扫影响膀胱癌患者预后,阳性淋巴结是膀胱癌患者预后的独立危险因素,规范盆腔淋巴结清扫术可延长患者术后生存时间。      

乳腺癌前哨淋巴结活检的临床探讨

目的:评估乳腺癌前哨淋巴结活检(Senital lymph node biopsy SLNB)对预测腋窝淋巴结转移状态的价值及其临床意义.方法:临床Ⅰ、Ⅱ期原发女性乳腺癌41例,体检无腋淋巴结肿大或虽有肿大而估计非转移性.术中在原发肿瘤周围注射亚甲蓝示踪定位,行SLNB和腋淋巴结清扫(Axillary lymph node dissection ALND).术后对全部前哨淋巴结(SLN)和腋淋巴结(ALN)行常规病理检查.结果:41例中检出SLN者32例,检出率为78.0%.其中N0组25例准确度为96.0%:阳性预测符合率100%;假阴性0例,阴性预测符合率100%.N1组7例准确度仅57.1%,假阴性2例,阴性预测符合率0.结论:应用亚甲蓝示踪定位SLNB,能准确预测(T1、T2)N0M0乳腺癌患者的转移状态,宜于推广应用.     

前哨淋巴结检测结果指导肿瘤＞2cm的Ⅰb1期宫颈癌行广泛性宫颈切除术的临床研究

摘 要：［目的］ 评价前哨淋巴结（SLN）对肿瘤＞2cm的Ⅰb1期宫颈癌患者盆腔淋巴结转移状态的预测价值,并探讨SLN检测结果指导经腹广泛性宫颈切除术（RAT）的临床意义。［方法］ 对45例保留生育功能治疗的肿瘤＞2cm的Ⅰb1期宫颈癌患者,术中检测SLN并原位切除,送快速冰冻病理检查排除盆腔淋巴结转移后,行RAT和盆腔淋巴清扫,术后将SLN和盆腔其他淋巴结送常规病理检查和抗角蛋白免疫组化检测。观察患者手术时间、术中出血量、术中术后并发症及术后复发、妊娠情况等指标,评价SLN检测指导肿瘤＞2cm的Ⅰb1期宫颈癌患者行RAT手术的可行性和安全性。［结果］ 45例患者均检出SLN,共检出145枚,平均3.2枚/例,检出率100.0%（45/45）。4例因术中快速冰冻病理发现SLN转移而改行广泛性子宫切除+盆腔淋巴清扫术,其余41例均成功行RAT。术后病理检查发现1例有1枚非SLN转移,SLN假阴性率为2.2%(1/45),SLN阴性预测值为97.6%(40/41)。抗角蛋白免疫组化检测未检出常规病理检查漏诊的微转移灶。SLN术中冰冻病理和术后病理的符合率为97.8%（44/45）。术中2例损伤一侧子宫动脉、1例损伤膀胱肌层,术后7例出现盆腔淋巴囊肿,3例残余宫颈管狭窄。术后完成随访38例,中位随访时间61个月,随访率为92.7%。术后19例有生育要求,5例妊娠,妊娠率26.3%。随访期间,2例复发,复发率为5.3%（2/38）。［结论］ SLN检测结果能准确预测肿瘤＞2cm的Ⅰb1期宫颈癌患者的盆腔淋巴结转移状态。希望保留生育功能的肿瘤＞2cm的Ⅰb1期宫颈癌患者,在SLN检测结果指导下行RAT是安全可行的。     

甲状腺乳头状癌前哨淋巴结活检的临床意义

目的 探讨甲状腺乳头状癌颈部前哨淋巴结(SLN)活检的准确性及可行性.方法 前瞻性分析23例临床淋巴结阴性(cNO)的甲状腺乳头状癌患者,术前2～5 h在超声引导下瘤体内注入99Tcm-右旋糖酐(99Tcm-DX)74 MBq,术中在肿瘤周围注入亚甲蓝0.2～0.4 ml.采用核素法(淋巴结闪烁显像法+γ探针法)和染料法定位SLN,并行术中冰冻病理检查,与术后颈清扫标本常规病理进行对照.结果 23例甲状腺乳头状癌患者均检测出SLN,检出率达100%(23/23).其中染料法和核素法的检出率分别为87.0%和100%.23例患者中,SLN冰冻阳性12例.1例术中冰冻检测SLN未发现转移癌而术后常规病理发现转移;1例SLN冰冻及病理均未发现转移,但颈清扫标本中非SLN(Ⅵ区)有转移.有21例患者的SLN活检结果与术后颈部淋巴结常规病理结果相符,准确度为91.3%(21/23),阳性预测值为100%(12/12),阴性预测值为81.8%(9/11).结论 SLN活检对预测cNO甲状腺乳头状癌的颈部淋巴结转移和指导临床治疗有重要的意义.     

盆腔淋巴结清扫术在Ⅰ期子宫内膜癌治疗中的价值

:[目的]探讨临床Ⅰ期子宫内膜癌盆腔淋巴结转移率及盆腔淋巴结清扫术的意义。[方法]对102例经盆腔淋巴结清扫术的临床Ⅰ期子宫内膜癌进行临床分期与手术 病理分期对照 ,分析病理类型、肿瘤细胞分级、肌层浸润深度与淋巴结转移的关系。[结果]临床Ⅰ期子宫内膜癌盆腔淋巴结转移率为10 8% ,其中Ⅰb 期(20 0%)高于Ⅰa 期(4 8%) ,内膜样腺癌、浆液性腺癌、腺鳞癌及透明细胞癌的淋巴结转移情况分别为8/88、1/4、1/5、1/5,盆腔淋巴结转移还与肿瘤细胞分级及子宫肌层浸润深度相关(P<0 05)。[结论]Ⅰ期子宫内膜癌的临床分期与手术 病理分期有较大差异。盆腔淋巴结清扫术可明确分期 ,尤其对Ⅰa(G2、3)期、Ⅰb(G1、2、3)期及特殊病理类型(如浆液性腺癌、腺鳞癌、透明细胞癌)意义重大     

纳米碳标记前哨淋巴结在早期宫颈癌诊疗中的价值研究

目的:探讨纳米碳标记前哨淋巴结活检（carbon nanoparticle labeled sentinel lymph node biopsy,SLNB）对早期宫颈癌患者诊疗的应用价值。方法:48例早期宫颈癌患者于宫颈3点、9点分别注射稀释后的纳米碳1 mL,腹腔镜下获取SLN后行广泛全子宫切除+盆腔淋巴结清扫术,切除的SLN及非前哨淋巴结行病理检查。结果:48例患者均检出SLN,平均每例患者检出(3±1.5)枚,显影率为100%,其中闭孔淋巴引流区为检出SLN最多的部位,其次为髂内、髂外和髂总动脉淋巴引流区。术后病理显示4例患者淋巴结阳性,阳性淋巴结共12枚,SLN 10枚,非SLN 2枚,而这4例淋巴结转移患者均被SLNB成功检出。SLNB假阳性率和假阴性率均为0,敏感性为100%（4/4）,准确性为100%（48/48）,阴性预测值为100%（44/44）。结论:纳米碳标记的SLNB可以准确预测早期宫颈癌患者盆腔淋巴结的转移情况。     

CT在妇科恶性肿瘤淋巴结转移中的诊断价值

目的探讨CT在妇科恶性肿瘤淋巴结转移中的诊断价值.方法对322例妇科恶性肿瘤初治患者进行全腹螺旋CT扫描,以CT影像上淋巴结清晰且最短径≥10mm或有中心性坏死视为淋巴结CT诊断阳性,并与手术后的病理诊断结果进行比较.结果322例患者中,CT报告显示盆腹腔淋巴结阳性66例;术后病理检查盆腹腔淋巴结转移34例;CT诊断淋巴结转移的敏感度为58.8%,特异度为84.0%;阳性预测值30.3%,阴性预测值为94.5%;Youden指数为0.43.结论螺旋CT检查对诊断妇科恶性肿瘤的盆腔淋巴结转移的特异度较高,可以为早期的子宫内膜癌及卵巢癌的淋巴结清扫范围提供参考.     

宫颈癌59例淋巴结转移情况简析

目的　分析宫颈癌患者后腹膜淋巴结的转移情况。方法　 5年来进行广泛性子宫和盆腔淋巴结切除的FIGOⅠ期和Ⅱ期患者 59例 ,其中 57例术前进行了间接法盆腔淋巴结造影。切除的淋巴结分装标记送病检。结果　有淋巴结转移者 1 8例 ,转移率 30 %。切除的淋巴结数目 1 3～ 35个 ,平均 2 2个。转移部位以髂内最多 ,其余依次为闭孔、髂外、髂总、腹股沟深淋巴结 ,右侧多于左侧 ,但P >0 .0 5。临床Ⅰ期淋巴结阳性 2 4 .3 % ;Ⅱ期 40 .9% ,P >0 .0 5。术前淋巴造影与术后病理相符 2例 ,不符 2 8例 ,二者无相关关系 ,P >0 .0 5。结论　宫颈癌患者的盆腔淋巴结转移问题不容忽视。目前采用的临床分期尚存在一定的局限性。盆腔淋巴结切除对临床Ⅰ期宫颈癌是必要的。淋巴结的转移部位无特殊性。间接法淋巴造影技术尚待改进     

结合前哨淋巴结冰冻检测阳性数免除早期乳腺癌腋窝清扫的可行性分析

摘 要：［目的］ 探究在后Z0011时代,冰冻检测的前哨淋巴结（sentinel lymph node,SLN）阳性数目对于术中腋窝进一步治疗的指导意义。［方法］ 回顾性分析2013年至2019年在浙江省肿瘤医院诊治的浸润性乳腺癌患者,术中SLN行冰冻检测。结合常规病理结果评估冰冻检测的效能。以SLN阳性数≤2枚和＞2枚作为分类,计算冰冻检测和常规病理检测SLN阳性数目的符合率。［结果］ 共有1 841例患者纳入研究,假阴性率为25.6%。宏转移、微转移和孤立肿瘤细胞转移的假阴性率分别为14.3%,58.2%和79.3%。有227例冰冻病理记录了SLN转移数目,冰冻病理检测与常规病理检测的SLN阳性数符合率为95.6%（217/227）。结合冰冻结果,87.2%（198/227）SLN阴性且符合Z0011标准的患者可免除腋窝淋巴结清扫。［结论］ 冰冻检测是一项安全有效的SLNB方法。结合术中冰冻检测的SLN阳性数目,符合Z0011标准的患者可以避免腋窝淋巴结清扫。     

MRI、分段诊刮及宫腔镜下刮宫诊断子宫内膜癌宫颈间质浸润效能比较

目的:比较子宫内膜癌患者术前盆腔MRI、分段诊刮、宫腔镜下刮宫结果与术后病理符合率,探讨三种术前检查方法在子宫内膜癌宫颈间质浸润诊断中的价值。方法:回顾2015年1月至 2019年10月在中国医科大学附属盛京医院妇科病房经手术病理证实的1 025例子宫内膜癌患者病例资料,对术前盆腔MRI、分段诊刮、宫腔镜下刮宫及术后病理结果等资料进行回顾性分析,比较手术前后各术前检查方案判断宫颈间质浸润的诊断指标及一致性。结果:MRI检查的阳性预测值（55.26%）、阴性预测值（93.72%）、符合率（90.03%）及约登指数（0.43）均高于分段诊刮（47.83%、87.50%、66.28%、0.408）及宫腔镜下刮宫（41.67%、92.52%、89.89%、0.20）。MRI检查与术后病理的一致性（κ=0.460）高于分段诊断性刮宫（κ=0.343）与宫腔镜下刮宫（κ=0.249）。分段诊刮判断子宫内膜癌宫颈间质浸润的误诊率达40.68%,宫腔镜下刮宫的漏诊率达76.74%。各术前检查方案中,MRI联合宫腔镜下刮宫检查的术前临床分期与手术病理分期相符率最高,I期96.07%,II期86.67%。结论:宫腔镜可直视宫颈部位有无异常,而MRI检查可在此基础上进一步判断宫颈间质浸润的情况,临床工作中应重视盆腔MRI检查联合宫腔镜下刮宫对子宫内膜癌患者术前分期的必要性。     

Relation between ovarian cancer and metastasis to pelvic lymph nodes

In our hospital, from Jan. 1983 to Oct. 1984, 20 patients with a variety of primary ovarian cancers was treated by radical operation: total hysterectomy with bilateral salpingo-oophorectomy, omentumectomy and unilateral or bilateral pelvic lymphadenectomy to study the metastatic condition in the pelvic lymph nodes. In 20 patients with primary ovarian cancer, 6 had positive pelvic lymph nodes, amounting to 30%. 12 stage I and II lesions of these 14 patients were negative in these nodes when first operated. But 2 patients with stage III lesions were positive, amounting to 14%. 6 patients underwent a second operation. Among them, 2 who had supplementary operation, were negative in the pelvic lymph nodes. The other 4 patients who had recurrence after the first operation were positive in the second one, amounting to 67%. Therefore, for the advanced, poorly-differentiated, infiltrative or recurrent cases, pelvic lymphadenectomy should be considered in addition to radical operation.     

Impact of surgical staging in evaluating the radiotherapeutic outcome in RTOG phase III study for A2 and B prostate carcinoma

Radiation Therapy Oncology Group (RTOG) protocol 7706 was a randomized Phase III study designed to test the value of elective (prophylactic) pelvic irradiation in addition to prostatic irradiation in patients with carcinoma of the prostate with no clinical evidence of tumor extension through the capsule. Eligible patients were those who had clinical Stage T1bNOMO (A2) or T2NOMO (B), who did not have curative surgery, and who had no evidence of lymph node metastases. Assessment of the regional lymphatics was mandatory but, at the discretion of the investigator, lymphangiography (LAG) or staging lymphadenectomy (SL) could be used. A total of 445 eligible and analyzable patients were entered in the study between 1978 and 1983 when the study was closed. The median follow-up was 7 years; minimum follow-up was 5 years. There were no significant differences in survival or local control whether treatment was administered to the prostate or to the prostate and pelvic lymph nodes. The nodal status for 117 (26%) patients was assessed by staging lymphadenectomy (SL) whereas for 328 (74%) patients it was assessed by lymphangiography (LAG). Pretreatment characteristics felt to have impact on survival were evaluated and found to be free of serious imbalance between the staging lymphadenectomy and lymphangiography groups. Compared to the lymphangiography group, the staging lymphadenectomy group showed better overall survival (87% to 76% at 5 years, p = .02), better disease-free survival (76% to 63% at 5 years, p = .008) and better metastases-free survival (88% to 82% at 5 years, p = .04). There was no difference between the groups in local control. The lymphangiography evaluation of pelvic nodes was clearly inferior for demonstration of the absence of pelvic node metastasis as reflected by reduced survival and increased metastasis.     

卵巢癌二次探查手术中淋巴结清扫的意义

背景与目的：盆腹腔淋巴结清扫是国际妇产联盟（FIGO）卵巢癌手术病理分期的主要内容之一,但在卵巢癌的二次探查手术中,盆腔和腹主动脉旁淋巴结清扫的价值还存在争议。本文拟分析有关资料,以对卵巢癌二次探查手术中淋巴结清扫的价值进行探讨。方法;收集中国医学科学院肿瘤医院1994年7月1日至1996年10月1日收治的15例Ⅲ期和Ⅳ期卵巢癌患者的临床资料并进行回顾性分析。结果：15例患者的组织病理类型均为卵巢浆液性乳头状囊腺癌;组织分化程度分别为：高分化2例、中分化7例、低分化6例。15例患者在初次细胞减灭术时均没有进行淋巴结清扫,“二探术”时患者的盆腔和腹主动脉旁淋巴结均为阴性。“二探术”阴性的10例患者中有4例（40％）发生肿瘤复发,复发部位为盆腔腹膜、腹腔和肝脏,盆腔和腹主动脉淋巴结均没有复发。结论：初次减灭术时淋巴结阴性的卵巢癌患者,在进行“二探术”时可不必进行淋巴结清扫。     

Value of and indications for pelvic lymph node dissection in the staging of prostate cancer

Pelvic lymphadenectomy is valuable as a staging procedure prior to radical prostatectomy in patients with clinical stages A2, B1 (except low-grade lesions), and B2 prostate cancer who seem to be good candidates for an attempt at curative surgery. Survival rates are promising in patients with negative pelvic lymph nodes and local tumors who undergo radical prostatectomy. In the presence of positive nodes, there is little reason to proceed with radical prostatectomy. Noninvasive alternatives to pelvic node dissection are appealing, but lymphangiography, ultrasound, computed tomography scanning, and magnetic resonance imaging are all less reliable than pelvic lymphadenectomy. Some morbidity is associated with surgical staging, and it is important that this be minimized. Pelvic lymph node dissection can play a role in treatment planning for patients who will be given external-beam radiation therapy. However, the role depends on the physician's treatment philosophy. In a recently reported series of patients receiving radiation therapy for localized prostate carcinoma, prior surgical staging by pelvic lymphadenectomy is uncommonly performed.     

Survival of Patients with Tumors of the Renal Pelvis and Ureter: A Retrospective Study

A review of 27 patients with renal pelvic tumors and ureteraltumors admitted to the Tsukuba University Hospital was performedretrospectively. Nineteen cases of renal pelvic tumors and elevencases of ureteral tumors were submitted to the study. Thesepatients were treated mainly by surgery. The rates for 1-year,3-year, 5-year and 10-year survival were 88.5%, 57.6%, 40.3%and 20.2%, respectively. No obvious relationship between prognosisof renal pelvic tumor and that of ureteral tumors was seen.Pathologically, there was a correlation between the grade andthe stage of the tumor. Prognosis was related to the stage ofthe tumor, but not to the grade of the tumor. Clinically, thepatients with positive urinary cytology had a poorer prognosis.It was considered that no relationship existed between the preoperativeclinical stage and the postoperative pathological stage. Consequently,the former is not considered a prognostic factor. We have been performing mainly radical nephroureterectomy withregional lymphadenectomy since 1975. The patients who receivedthe operation with regional lymphadenectomy or with adjuvantchemotherapy had a better prognosis. It is concluded that lymphadenectomyis a valuable operation for improving prognosis.     

小儿睾丸肿瘤腹膜后淋巴结清扫与AFP变化

目的探讨腹膜后淋巴结清扫术以及AFP在小儿睾丸肿瘤治疗中的价值。方法43例小儿睾丸肿瘤中有27例行腹膜后淋巴结清扫术。16例AFP升高，随访32例存活29例，其中淋巴结清扫16例，未清扫13例，存活病例中术前AFP阳性8例。结果腹膜后淋巴结清扫组的存活率与未清扫组无显著差异，术前AFP阳性的存活率与阴性者亦无显著差异。结论不应将腹膜后淋巴结清扫术作为小儿睾丸肿瘤的常规治疗；术前AFP升高与预后无相关关系。     

Aspiration cytology in the staging of urologic cancer

Knowledge of the status of the pelvic lymph nodes is vital for accurate staging and adequate treatment of patients with urologic cancer. Noninvasive techniques for assessing the lymphatic spread of urologic neoplasms have proved to be of limited value. Bipedal lymphangiography and percutaneous fine needle aspiration cytology under fluoroscopic guidance were performed for staging purposes in 71 patients with clinically localized bladder, prostatic and penile cancer from 257 nodal chains. The overall diagnostic accuracy was 93% and the correct aspiration of 186 lymph nodes was surgically confirmed. There were 11 (6%) false-negative biopsy results and no false-positive diagnoses. Aspiration cytology is a safe, well tolerated, accurate, and rapid method of determining the presence of metastatic disease in lymphangiographically visualized pelvic nodes. In the management of prostatic carcinoma, positive cytologic results are diagnostic of nodal metastatic involvement and spare the patients unnecessary surgical staging. Negative cytologic findings may be considered diagnostic of localized disease in the patients with well differentiated prostatic carcinoma (2-4 Gleason's sum). Since most surgeons are reluctant to perform a staging lymphadenectomy in the management of invasive bladder carcinoma, aspiration cytology can provide accurate staging, thus permitting an appropriate treatment plan. In patients with carcinoma of the penis, a positive aspirate permits an early and even curative lymphadenectomy in cases with clinically negative but pathologically positive nodes.     

早期宫颈癌前哨淋巴结中高危型HPV16/18 DNA表达的检测及临床意义

目的：探讨早期宫颈癌患者前哨淋巴结（SLN）中人乳头状瘤病毒（HPV）16/18 DNA表达检测对于微转移的临床意义。方法选取72例早期宫颈癌患者,予患者均行广泛性子宫切除加双侧盆腔淋巴结清扫术,术中采用染料法识别SLN的宫颈癌患者有46例,应用基因检测法（FQ-PCR）检测SLN中HPV16/18 DNA阳性表达情况,并分析其与各种临床病理因素的关系;对SLN病理阴性的33例患者进行长期随访,分析SLN中HPV16/18 DNA阳性与淋巴结转移的关系。结果46例宫颈癌患者SLN中HPV16/18 DNA阳性表达者共22例,其中13例淋巴结病理阳性患者中有10例阳性,而33例淋巴结病理阴性患者中仅12例阳性（P=0.013）;46例患者共检出前哨淋巴结102枚,均用FQ-PCR法检测HPV16/18 DNA,结果13例淋巴结病理阳性患者检出的37枚SLN中有29枚HPV16/18 DNA阳性,而33例淋巴结病理阴性患者检出的65枚SLN中仅有36枚阳性（P=0.033）;分析46例成功检出SLN的早期宫颈癌患者的临床资料,发现SLN中HPV16/18 DNA阳性表达仅与临床分期有关,具有统计学意义（P=0.034）;长期随访33例SLN病理阴性的患者,发现HPV16/18 DNA阳性的患者复发率高于HPV16/18 DNA阴性的患者,具有统计学意义（P=0.02）。结论检测宫颈癌SLN组织中HPV16/18 DNA表达可能是预测早期宫颈癌淋巴结微转移的可行方法。     

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.