应用高频电波刀电圈切除术治疗宫颈上皮内瘤样病变临床护理

目的探讨应用高频电波刀电圈切除术(LEEP)治疗宫颈上皮内瘤样病变的护理方法及注意事项.方法LEEP术前对患者做好心理护理,术中保护阴道壁,避免阴道壁灼伤,术后防止感染.结果LEEP治疗宫颈上皮内瘤样病变操作简便,并发症少,治愈率达89.4%～93.39%.结论LEEP治疗宫颈上皮内瘤样病变,精心护理可使LEEP的优越性得到更充分发挥.     

低温高频电波刀在宫颈上皮内瘤样病变治疗中的应用

目的:评价低温高频电刀(LEEP)治疗宫颈上皮内瘤样病变(Cervical intraepithelial neopla,CIN),探讨其治疗效果。方法:通过2006年4月~2007年12月门诊患者及体检人群,经宫颈细胞学检查(薄层液基细胞学,Liquid-based Cytology),在阴道镜检(colposcopy)下多点活组织检查(multi-point biopsy),筛查出宫颈上皮内瘤样病变(CIN)174例患者,采用低温高频电刀(LEEP)治疗。结果:12周一次成功率98.85%(172/174),术中出血量平均35 mL,平均手术时间9.8分钟。结论:LEEP刀治疗宫颈上皮内瘤病变(CIN),操作简便、快捷、安全、有效、出血少、手术时间短,不需住院,患者容易接受,有效的治疗可以降低宫颈癌的发生率。     

LEEP治疗宫颈上皮内瘤变68例临床分析

对68例宫颈上皮内瘤样病变Ⅰ～Ⅲ级的门诊患者行宫颈电圈环切术(LEEP)治疗,切除组织送病理检查。LEEP治疗各级宫颈上皮内瘤样病变一次性成功率达94%,手术时间5～10min,出血量5～20ml,术后3、6、9、12个月共随访1年行TCT检查,结果66例阴性,2例宫颈上皮内瘤样病变(CIN)Ⅰ级。LEEP是CIN的一种有效、简便、经济、安全、创伤小的诊治方法。     

宫颈电切割术在中重度宫颈上皮内瘤样病变治疗中的应用

目的:评价宫颈电切割术(LEEP术)在中、重度宫颈上皮内瘤样病变治疗中的应用价值.方法:用LEEP术对经阴道镜下病理活检诊断为中、重度宫颈上皮内瘤样病变(CIN Ⅱ、Ⅲ级)患者90例进行治疗,根据病检结果进行相应的处理,并对其疗效及并发症等相关问题进行回顾性分析.结果:术前、术后病理诊断一致者占90%(81/90);术后病理诊断级别上升占2%(2/90),有1例病栓为浸润癌行广泛性子宫切除+盆腔淋巴清扫术,1例为原位癌行子宫全切术;术后病理诊断级别降低占8%(7/90);无一例感染和颈管狭窄,无手术切缘阳性者.结论:LEEP术后病理诊断是阴道下多点活检的补充诊断,对于中、重度宫颈上皮内瘤样病变(CIN Ⅱ、Ⅲ级)患者,及早行LEEP术诊断和治疗可以早期发现宫颈恶性病变.     

高频电切治疗宫颈上皮内瘤样病变120例临床分析

目的探讨高频电切(LEEP)治疗宫颈上皮内瘤样病变临床效果。方法经阴道镜及镜下活检诊断为宫颈上皮内瘤变120例患者采用LEEP治疗切除组织送病理检查。结果LEEP手术对C INⅠ、Ⅱ者治愈率达100%,随诊1~3年无复发。结论LEEP术广泛用于治疗宫颈上皮内瘤变,是一种理想的诊断治疗手段,操作简单、安全。     

腔镜电切术与宫颈环形电切术治疗宫颈上皮内瘤样病变的疗效对比

目的 探讨腔镜电切术(TCRC)与宫颈环形电切术(LEEP)治疗宫颈上皮内瘤样病变各自的优劣势.方法 2010年1月至2012年1月门诊就诊的100例宫颈上皮内瘤样病变患者,随机分为治疗组、对照组各50例,治疗组应用TCRC,对照组应用LEEP,比较两组的术中出血量、手术时间、术后并发症及治疗疗效.结果 治疗组、对照组的治愈率、残留率、持续存在率、复发率、术后并发症、手术时间差异均不明显(P均＞0.05);治疗组术中出血量显著少于对照组(P＜0.05).结论 TCRC治疗宫颈上皮内瘤样病变术中出血量明显少于LEEP,在手术时间、术后并发症、治愈率方面TCRC与LEEP接近,临床医师可根据临床实际情况进行方法的选择.     

LEEP刀治疗宫颈上皮内瘤样病变60例临床观察

目的:探讨LEEP刀治疗宫颈上皮内瘤样病变的临床疗效。方法:2016年2月至2017年10月在本院收治的宫颈上皮内瘤样病变患者中选取60例,随机分为对照组与观察组,各30例。对照组采用冷刀宫颈锥切术治疗,观察组采用LEEP刀治疗,对比两组手术疗效。与对照组相比,观察组在手术时间、术中出血量、排液时间、切口愈合时间方面明显更少(P <0.05),差异有统计学意义。对比术后并发症发生率,观察组明显低于对照组(P <0.05),差异有统计学意义。对比手术治愈率与宫颈塑性满意率,观察组均明显高于对照组(P <0.05),差异有统计学意义。结论:LEEP治疗宫颈上皮内瘤样病变疗效显著,安全可靠。     

LEEP治疗宫颈上皮内瘤样病变108例临床探讨

目的探讨高频电波刀（LEEP）治疗宫颈上皮内瘤样病变（CIN）的临床效果。方法经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108例患者,采用LEEP治疗,切除组织送病理检查。结果LEEP治疗宫颈各级CIN一次性成功率达到96．30％,手术时间5-10min,出血量15ml,术后随访108例TCT检查结果104例阴性,3例CINⅠ～Ⅱ级,1例CINⅡ级。阴道镜检查均阴性。结论LEEP广泛用于治疗宫颈上皮内瘤样病变是一种理想的诊断治疗手段,操作简单、安全。     

不同LEEP术式治疗宫颈上皮内瘤样病变和宫颈糜烂的疗效观察

探讨不同LEEP术式治疗宫颈上皮内瘤样病变和宫颈糜烂的临床疗效。选取收治的行LEEP术式治疗的宫颈上皮内瘤样病变和宫颈糜烂患者120例,根据病变情况实施不同术式,包括浅宫颈环切术(SRE)、深宫颈环切术(DRE)和宫颈锥切术(LEEPC)。观察不同LEEP术式的治疗效果及术后并发症情况。三种术式治疗后6个月CIN的疗效为SRE组治愈率88.4%,DRE组治愈率89.5,LEEPC组治愈率87.2;治疗宫颈糜烂的治愈率分别为90.7%、92.1%、89.7%,三组比较差异无统计学意义(P0.05)。在宫颈上皮内瘤样病变和宫颈糜烂的治疗中,根据不同病变程度选取不同的LEEP手术方式均具有较好的临床治疗效果,术后恢复快,术后复发几率低,具有较好的临床应用价值,值得推广使用。     

宫颈电切割术在中重度宫颈上皮内瘤样病变治疗中的应用-附90例临床分析

目的：评价宫颈电切割术（LEEP术）在中、重度宫颈上皮内瘤样病变治疗中的应用价值。方法：用LEEP术对经阴道镜下病理活检诊断为中、重度宫颈上皮内瘤样病变（CINⅡ、Ⅲ级）患者90例进行治疗，根据病检结果进行相应的处理，并对其疗效及并发症等相关问题进行回顾性分析。结果：术前、术后病理诊断一致者占90％（81／90）；术后病理诊断级别上升占2％（2／90），有1例病检为浸润癌行广泛性子宫切除＋盆腔淋巴清扫术，1例为原位癌行子宫全切术；术后病理诊断级别降低占8％（7／90）；无一例感染和颈管狭窄，无手术切缘阳性者。结论：LEEP术后病理诊断是阴道下多点活检的补充诊断，对于中、重度宫颈上皮内瘤样病变（CINⅡ、Ⅲ级级）患者，及早行LEEP术诊断和治疗可以早期发现宫颈恶性病变     

癌抗原125在上皮样肉瘤组织和血清中表达的意义

目的 :观察肿瘤标志物癌抗原125(CA125)在上皮样肉瘤(epithelioid sarcoma,ES)患者组织和血清中的表达情况,并探讨血清CA125水平与患者疗效及预后间的关系。方法:选取本院8例确诊的ES患者(男5例,女3例),另选取上皮样血管肉瘤和上皮样恶性外周神经鞘膜瘤患者各2例作为对照,采用免疫组织化学检测肿瘤组织中CA125的表达,同时收集1例随访最系统、详尽的ES复发患者治疗过程中不同时段血清CA125水平(术前1次,术后10次),结合患者的治疗及预后情况,研究肿瘤标志物CA125与患者疗效间的相关性。结果:8例患者手术切除的ES组织免疫组织化学检测提示CA125表达均为阳性,上皮样血管肉瘤和上皮样恶性外周神经鞘膜瘤则无CA125阳性表达。ES患者经综合治疗后,在随访期内(8~102个月,平均60.13个月),5例患者治愈,肿瘤无复发,其余3例肿瘤复发。其中1例术后半年复发的患者,术前血清学CA125高表达,术后10次复查中血清CA125表达比术前明显下降,但仍高于正常值并逐渐增高。结论:免疫组织化学CA125的阳性表达可能成为ES的一项重要诊断指标,且推测ES患者血清CA125水平的动态变化可能与其临床疗效及预后相关。     

肋骨原发性上皮样肉瘤临床病理分析

目的探讨肋骨原发性上皮样肉瘤的临床病理特征、免疫表型及生物学行为。方法对1例原发于肋骨的上皮样肉瘤标本,通过光镜、免疫组化及电镜等方法进行病理组织学观察,并回顾分析相关文献报道。结果本例肿瘤原发于肋骨。肿瘤细胞结节状排列,浸润性生长,瘤细胞大部分由相对独特的上皮样细胞组成,核卵圆形,胞质丰富,嗜酸性,玻璃样。肿瘤中心常见变性坏死。免疫组化示EMA、CK和vimentin( )。电镜显示肿瘤细胞有大量的细丝、细胞间桥和细胞连接。结论原发于肋骨的上皮样肉瘤比较罕见,形态学相对复杂多样,诊断较困难。根据其组织学和病理学特征,结合免疫组化染色结果可以做出明确诊断。     

超声诊断肢体上皮样肉瘤的临床价值

目的 探讨超声在肢体上皮样肉瘤诊断中的临床价值。方法 收集我院经手术病理证实为肢体上皮样肉瘤患者43例资料,分析其术前超声图像特征,并随访其短期复发情况。结果 43例肢体上皮样肉瘤超声均明确提示病变位置,定位准确率100%;声像图表现均呈团块状低回声,均无包膜,平均最大径（5.73±4.99）cm,为以实性为主（81.4%）,边界不清晰（55.8%）,形态不规则（88.4%）,内部回声不均匀（95.3%）,多为单发（72.1%）,血流分级Ⅲ级（53.5%）。超声明确提示软组织肿物42例,另有1例患者肿物感不明显,超声提示为神经病变,瘢痕粘连。术后随访3个月至8年,出现复发并再次手术者22例,超声均直接提示复发,声像图均表现为回声不均匀的实性低回声,边界不清晰（15/22）,形态不规则（16/22）,Alder血流分级均为Ⅰ级。结论 肢体上皮样肉瘤声像图表现多为单发不规则团块状实性低回声肿物,无包膜,边界不清晰,内部回声不均匀,血流较丰富。超声不仅可在术前明确病变范围及其周围组织受累情况,术后亦可动态随访,具有重要的临床价值。     

Epithelioid leiomyosarcoma of the vulva: report of a rare case and literature review

Leiomyosarcoma of the vulva is a rare soft tissue sarcoma that accounts for approximately 1% of all primary vulvar neoplasms, but it is the most common type of vulvar sarcoma. It usually originates from the smooth muscle within erectile tissue or blood vessel walls, the round ligament, the dartos muscle or the arrector pili muscle. No treatment algorithms have been established to date. Surgical resection is preferred for vulvar leiomyosarcoma. Currently, the recommended surgical method is extensive local resection with a safe surgical margin of at least 2 cm. The use of chemoradiotherapy for vulvar sarcoma remains controversial. This case report describes a 39-year-old female that underwent resection of a vulvar mass in January 2019. Postoperative pathological examination indicated that it was an epithelioid leiomyosarcoma. She presented with tumour recurrence after 43 days. Based on the diagnosis, radical right vulvectomy with a tumour margin of 2 cm was performed. The tumour margin was negative. The patient refused to undergo auxiliary radiotherapy and chemotherapy. The follow-up findings do not indicate any signs of recurrence. In order to avoid recurrence, vulvar epithelioid leiomyosarcomas should be completely resected with a margin of 2 cm at the time of first occurrence.     

Sarcoma-associated sarcoid reaction: Report of cutaneous sarcoid reaction in a patient with liposarcoma

Sarcoidosis is a systemic inflammatory condition in which noncaseating epithelioid cell granulomas appear within one or several body sites. Sarcoid reaction(also referred to as sarcoidal or sarcoid-like reaction) occurs in patients who do not fulfill the diagnostic criteria for systemic sarcoidosis but present with similar clinical and histological features. As sarcoma-associated sarcoid reactions are rare, we describe the features of sarcoid reaction that developed in a man with liposarcoma and summarize reports of other oncology patients with sarcoma-associated sarcoid reactions. A 68-yearold man with retroperitoneal liposarcoma presented for evaluation of erythematous dermal plaques on his left leg. Microscopic examination of a tissue specimen revealed multiple epithelioid granulomas in the superficial and mid-reticular dermis. Correlation of the clinical presentation and histopathologic findings established a diagnosis of liposarcoma-associated cutaneous sarcoid reaction. Sarcoid reactions have been described in only seven individuals with sarcoma, including two patients with leiomyosarcoma and one patient with either carcinosarcoma, Kaposi sarcoma, liposarcoma, malignant peripheral nerve sheath tumor, rhabdosarcoma, or synovial sarcoma. Sarcoidal granulomas most commonly develop within the locoregional draining lymph nodes. Sarcoid reactions may also affect other organs, such as the lungs, skin, and spleen.     

30例子宫肉瘤病人的治疗及护理

[目的]总结子宫肉瘤病人的治疗以及护理要点.[方法]回顾性分析30例子宫肉瘤病人的临床资料.[结果]病人以手术治疗为主,辅以化疗及放疗并采取相应的护理.[结论]子宫肉瘤早期症状无特异性,易误诊,治疗手段繁复,时间长,综合治疗配合全面护理尤为重要.     

原发性胃肠道透明细胞肉瘤一例及文献复习

目的：探讨原发性胃肠道透明细胞肉瘤的临床病理特点、鉴别诊断及生物学行为。方法收集1例原发性胃肠道透明细胞肉瘤病例的临床资料,行光镜观察、免疫组织化学（ Envision法）标记和电镜观察,并复习相关文献。结果肿瘤位于回肠末端。组织学上,病变位于黏膜下,周界不清,明显浸润性生长,见淋巴结转移。肿瘤组织主要呈弥漫片状、巢状排列,其间散在多核破骨细胞样巨细胞,分布疏密不均。肿瘤细胞形态相对一致,呈短梭形、卵圆形,胞质丰富,透亮或略嗜酸。免疫组化标记显示,肿瘤细胞弥漫阳性表达S-100,破骨样巨细胞表达CD68,Ki-67增殖指数约20％。电镜观察显示瘤细胞内未见典型黑色素小体和神经内分泌颗粒,破骨样巨细胞则具有组织细胞分化。随访结果显示患者于术后21个月死亡。结论原发性胃肠道透明细胞肉瘤是一种非常少见的肿瘤,具有高度侵袭性,预后差,对该肿瘤确诊依赖于临床表现、组织学形态、免疫表型相结合,且需要和其他肿瘤如转移性透明细胞肉瘤、上皮样胃肠道间质瘤,伴破骨样巨细胞的平滑肌肉瘤及血管周上皮样细胞肿瘤等鉴别。     

Epithelioid leiomyosarcoma with rhabdoid features

Leiomyosarcomas (LMS) are the most common type of uterine sarcoma. Most LMS have typical histologic features, and variants such as epithelioid LMS, myxoid LMS, LMS with osteoclast-like giant cells and LMS with rhabdoid features occur only rarely. Rhabdoid cells were first described in rhabdoid tumor, a distinctive renal neoplasm of infancy. Such tumors are composed of diffuse proliferation of rhabdoid cells that are round or polygonal in shape with eccentric nuclei, prominent nucleoli and glassy eosinophilic cytoplasm containing hyaline-like inclusion bodies. In the literature, extrarenal localizations of malign rhabdoid tumors have been described in a variety of primary sites such as the central nervous system, liver, skin and soft tissues. These characteristic rhabdoid cells have been reported in sarcomas and carcinomas of various types and in a few cases of uterine sarcomas. The presence of rhabdoid cells in tumors is considered to be a predictor of aggressive tumor behavior. Our case is that of a 56-year-old woman who was admitted to the state hospital with left inguinal mass. Microscopically the tumor was admixed of three different types of cell with spindle, epithelioid or rhabdoid features. Immunopositive cytoplasmic staining for myoglobulin and desmin was seen in rhabdoid cells, and cytokeratin immunopositivity was observed in epithelioid and some rhabdoid cells. Epithelioid cells and spindle cells were also SMA positive. The histopathologic and immunohistochemical findings support the diagnosis of epithelioid LMS with rhabdoid features. We report this very uncommon LMS variant; to the best of our knowledge there are only a few cases in the English literature.     

宫颈粒细胞肉瘤临床病理观察

目的探讨宫颈粒细胞肉瘤的临床病理学特征、诊断及鉴别诊断：方法结合文献对1例罕见的宫颈粒细胞肉瘤的临床表现、组织形态学特点、免疫组化及治疗和预后进行探讨。结果宫颈粒细胞肉瘤以宫颈肿块为首要表现，形态学上肿瘤细胞弥漫分布，小至中等大小，胞质少，核圆形、椭圆形，染色质细腻，核分裂易见。免疫组化肿瘤细胞MPO、CD15、CD68和溶菌酶（＋）。结论宫颈粒细胞肉瘤是一种罕见肿瘤，仅凭形态学易误诊为淋巴瘤、ES／PNET、小细胞癌等。了解其本质有助于早期诊断和进行恰当的治疗。