Cytology, colposcopy and cervical neoplasia

There have been suggestions that the failure to reduce the incidence of cervical carcinoma in New Zealand is due to a failure to take cervical smears from women at risk, and to appropriately manage those with abnormal smears. Review of data collected from a clinic in Christchurch over a four-year interval found that the majority of those with invasive cancer had never had a smear taken, or had not had smears taken frequently enough. There was evidence that cytology does not always correlate with definitive histology, and that patients with abnormal smears sometimes experienced lengthy delays before being referred for management. Comments are made on who should have smears, how often, and how women with abnormal smears should be managed.     

高危型HPV感染与宫颈癌前病变及宫颈癌的相关性研究

目的研究与分析高危型人乳头瘤病毒（HPV）感染与宫颈癌前病变及宫颈癌的相关性。方法本文选择番禺区本地户籍妇女进行调查研究,选择其中580例作为研究对象,随机分为三组,癌前病变组296例,宫颈癌组80例。对照组204例为宫颈无细胞学改变,采用宫颈刮片、宫颈液基细胞学检查法进行遴选筛查分析．同时应用达安PCR-反向点杂交法检测16种高危型HPV及3种低危型HPV,对各组检测结果进行比较分析。结果HPV总阳性率为51．03％（296／580）,癌前病变组、对照组以及宫颈癌组的HPV阳性率分别为66．89％（198／296）、10．29％（21／204）、96．25％（77／80）,3组患者感染率差异具有统计学意义（P〈0．05）。HPV分型的296例患者,高危型主要为HPV16型,占34．8％（103／296）。结论高危型HPV感染和宫颈癌以及宫颈癌前病变存在着紧密的联系,在高危型HPV感染当中最为主要的是HPV16。     

宫颈鳞癌及癌前病变组织中ILK、PTEN的表达情况

目的：探讨宫颈鳞癌及癌前病变组织中整合素连接激酶（ILK）、PTEN的表达情况。方法：采用免疫组化方法对50例宫颈鳞癌,28例CIN和12例正常宫颈组织进行ILK、PTEN检测,并结合临床资料进行统计分析。结果：宫颈鳞癌ILK阳性表达率明显高于正常组织和CIN1、2级组织,ILK表达与肿瘤浸润、转移和临床分期密切相关;正常宫颈组织PTEN均呈阳性表达,而宫颈浸润癌组织PTEN表达率明显降低,但PTEN表达与肿瘤浸润、转移和临床分期无明显相关性。结论：宫颈鳞癌组织ILK呈高表达、PTEN呈低表达,可能在宫颈肿瘤浸润转移过程中起重要作用。     

Costs of detection and treatment of cervical cancer,cervical dysplasia and genital warts in the UK

ABSTRACT

Objective: Infection with human Papillomavirus (HPV) is a necessary cause of cervical cancer (CC) and genital warts (GW). HPV vaccination studies have shown excellent efficacy against HPV-induced lesions. To assess the cost-effectiveness of a HPV quadrivalent (6, 11, 16 and 18) vaccine it is necessary to estimate the costs of managing current levels of HPV-related diseases. This study estimates the annual 2003 expenditures in the UK for CC screening, follow-up of abnormal findings, CC treatment and GW treatment.

Design and methods: CC screening programmes provided the annual number of screening tests, their results and use of colposcopy procedures in women with abnormal findings. Incident CC cases and hospital admissions for CC in 2003 were used to estimate CC costs. Health Protection Agency data provided the annual number of new, recurrent or persistent cases of GW treated in Genitourinary Medicine (GUM) clinics. Treatment patterns for managing GW were estimated by GUM clinicians. The annual physician visits, tests, procedures, hospital admissions and topical genital wart medications were costed to estimate the total annual expenditures for CC and GW.

Results: There were 4.8 million screening tests and 230?303 colposcopy procedures. Estimated costs for screening, management of abnormal and inadequate findings were £138.5 million. Annual management costs for incident and prevalent CC cases were £46.8 million. There were an estimated 76?457 incident and 55?657 recurrent/persistent GW cases in 2003. The costs for managing these cases were approximately £22.4 million. Total annual estimated costs for CC screening, management and treatment of GW were £208 million and ranged from £186.9 to £214 million based upon sensitivity analyses.

Conclusions: The direct medical costs for the NHS associated with detection and management of CC, cervical dysplasia and treatment of GW in the UK are substantial. These medical costs are invaluable for future cost-effectiveness analyses of a quadrivalent HPV vaccine programme.     

Costs of detection and treatment of cervical cancer, cervical dysplasia and genital warts in the UK

OBJECTIVE: Infection with human Papillomavirus (HPV) is a necessary cause of cervical cancer (CC) and genital warts (GW). HPV vaccination studies have shown excellent efficacy against HPV-induced lesions. To assess the cost-effectiveness of a HPV quadrivalent (6, 11, 16 and 18) vaccine it is necessary to estimate the costs of managing current levels of HPV-related diseases. This study estimates the annual 2003 expenditures in the UK for CC screening, follow-up of abnormal findings, CC treatment and GW treatment. DESIGN AND METHODS: CC screening programmes provided the annual number of screening tests, their results and use of colposcopy procedures in women with abnormal findings. Incident CC cases and hospital admissions for CC in 2003 were used to estimate CC costs. Health Protection Agency data provided the annual number of new, recurrent or persistent cases of GW treated in Genitourinary Medicine (GUM) clinics. Treatment patterns for managing GW were estimated by GUM clinicians. The annual physician visits, tests, procedures, hospital admissions and topical genital wart medications were costed to estimate the total annual expenditures for CC and GW. RESULTS: There were 4.8 million screening tests and 230 303 colposcopy procedures. Estimated costs for screening, management of abnormal and inadequate findings were 138.5 million pounds sterlings. Annual management costs for incident and prevalent CC cases were 46.8 million pounds sterlings. There were an estimated 76 457 incident and 55 657 recurrent/persistent GW cases in 2003. The costs for managing these cases were approximately 22.4 million pounds sterlings. Total annual estimated costs for CC screening, management and treatment of GW were 208 million pounds sterlings and ranged from 186.9 pounds sterlings to 214 million pounds sterlings based upon sensitivity analyses. CONCLUSIONS: The direct medical costs for the NHS associated with detection and management of CC, cervical dysplasia and treatment of GW in the UK are substantial. These medical costs are invaluable for future cost-effectiveness analyses of a quadrivalent HPV vaccine programme.     

尖锐湿疣、宫颈上皮内瘤变及宫颈鳞形细胞癌中人乳头状瘤病毒的分析

目的 :探讨不同种类人乳头状瘤病毒 (HPV)感染与病变性质的关系。方法 :采取DNA原位杂交技术检测尖锐湿疣38例 ,宫颈上皮内轻度瘤变 (CINⅠ )35例 ,宫颈上皮内中度瘤变 (CINⅡ )27例 ,宫颈上皮内重度瘤变 (CINⅢ )29例 ,宫颈鳞形细胞癌36例和正常生殖道55例。对HPV -DNA进行检测并对HPV感染的主要类型进行分析。结果 :尖锐湿疣中 ,HPV -DNA检出率为94.7 %,HPV6和HPV11占其中的86.1 % ,宫颈癌中HPV -DNA检出率为91.6 % ,HPV16和HPV18为主要类型占81.8 % ;而在CINⅠ -CINⅢ中 ,HPV -DNA检出率分别为80 %、77.8 %、82.8 %。CINI中HPV6、11型占67.8 %。而CINⅡ及CINⅢ中 ,HPV16、18分别占52.4 %及79.2 % ;对照组中HPV隐匿感染率为32.7 %。结论 :低危险型HPV6.11主要引起外生殖器湿疣等良性病变包括CI NI,高危险型HPV如HPV16、18与宫颈癌及宫颈上皮内中、高度瘤变的发生相关。     

宫颈扩张球囊应用于足月妊娠引产孕妇对分娩情况 促宫颈成熟和并发症的影响

目的探究宫颈扩张球囊应用于足月妊娠引产孕妇对分娩情况、促宫颈成熟和并发症的影响。方法选取我院2015年7月至2017年7月收治的足月妊娠引产孕妇120例,按照数字随机表法分为2组,各60例。对照组采用催产素静脉滴注引产,观察组采用一次性宫颈扩张球囊引产。对比2组分娩情况、促宫颈成熟效果及并发症发生率。结果观察组阴道分娩率高于对照组,差异有统计学意义(P<0.05);观察组引产至临产时间、总产程时间均短于对照组,产后出血量少于对照组,差异有统计学意义(P<0.05);观察组促宫颈成熟效果优于对照组,差异有统计学意义(P<0.05);观察组胎膜早破发生率低于对照组,差异有统计学意义(P<0.05);观察组宫颈出血、排尿不畅、宫缩过频发生率与对照组比较,差异无统计学意义(P>0.05)。结论宫颈扩张球囊应用于足月妊娠引产孕妇可有效改善分娩结局,提高促宫颈成熟效果,且未增加并发症发生率,值得临床推广。     

宫颈细胞学检查、HPV—DNA检测配合阴道镜检查对子宫颈病变的诊断价值

目的 分析与探讨宫颈细胞学检查、HPV-DNA（人乳头瘤病毒基因检测）检测配合阴道镜检查对于子宫颈病变的诊断价值.方法 选取本院2010年8月至2012年8月期间收治的接受子宫颈病变筛查的妇女共1020例,对其实施宫颈细胞学检查和HPV-DNA配合阴道镜检查,检查结果与组织学金标准进行比对,以对比两种方法的准确性与诊断价值.结果 采取HPV-DNA配合阴道镜检查为异常结果的检出率较宫颈细胞学检查更高,差异具有统计学意义（P＜0.05）,前者检出异常共64例,后者检出异常共34例.结论 宫颈细胞学检查、HPV-DNA检测以及阴道镜检查对于子宫颈病变均有一定的诊断价值,而采用HPV-DNA检测配合阴道镜检查能够帮助医生较早地发现患者的宫颈癌前病变,为患者的治疗方案的选择提供科学依据.     

宫颈癌的筛查、早期诊断与治疗

1宫颈癌的筛查方法巴氏细胞学检查,即宫颈刮片细胞学检查,又名巴氏涂片法(Pap Smear),是以该检查方法的发明者George Papanicolaou博士的名字命名的。1943年,Papanicolaou和Traut发表了著名的宫颈细胞学论文,首次将宫颈细胞学检查作为宫颈癌的一种筛查方法。此后,巴氏涂片就成为了宫颈癌筛查中最常用的一种方法。迄今,其已经应用     

P53,P16,PRb的表达与宫颈上皮病理改变的关系

目的探讨P16,P53和PRb在宫颈上皮内瘤变和宫颈癌中的表达及意义。方法用免疫组化的方法检测44例宫颈上皮内瘤变,12例宫颈鳞癌和10例宫颈炎标本中P16,P53和PRb的表达情况。结果 P16在宫颈炎、CIN和宫颈癌的阳性表达率为0%,90.9%,100%,其表达有统计学意义（P〈0.01）;P53在宫颈炎、CIN和宫颈癌的阳性表达率为10%,36.1%,41.7%,表达无统计学意义（P=1.00）;PRb的表达率为0%,95.5%,100%。（P〈0.01）具有统计学意义。从宫颈炎-CIN-宫颈癌的演变过程中,P16和PRb的表达成递增趋势,具有高度相关性（r=0.807,0.668）,而P53的表达与疾病演变过程呈低度相关性（r=0.331）。结论 P16和PRb的表达强度在宫颈CIN到宫颈癌的演变过程中逐步升高,P53表达则主要出现在病变的早期阶段。P16,PRb和P53结合应用有助于宫颈CIN分级和宫颈癌的诊断及鉴别诊断。     

CDK8、KAI1蛋白在宫颈癌及宫颈上皮内瘤变中表达对患者预后的影响

目的：探讨CDK8（cyclin-dependent kinase 8）、KAI1蛋白在宫颈癌及宫颈上皮内瘤变中表达对患者预后的影响分析,为临床诊断治疗提供参考。方法采用免疫组织化学染色法,检测CDK8、KAI1蛋白在20例正常宫颈组织、110例CIN（ cervical intraepithelial neoplasia）组织、36例宫颈癌组织中的表达,比较不同组织中CDK8、KAI1表达的差异;检测36例宫颈癌组织中CDK8、KAI1蛋白的表达情况,分析CDK8、KAI1与宫颈癌临床特征的相关性,统计相关资料随访患者复发及预后情况。结果随着病情发展,CDK8在正常组织、CIN低度病变组织、CIN高度病变组织、宫颈癌组织中的表达呈显著递增的趋势（ P＜0．05）,CDK8在宫颈癌组织的表达与淋巴结转移呈正相关,36例宫颈癌患者随访后,临床Ⅰ、Ⅱ、Ⅲ期死亡率分别为13．33％、20．08％、37．50％,淋巴结转移死亡率（46．67％）显著大于淋巴结无转移（19．05％）,且差异有显著性（P＜0．05）,随着病情的加重,CDK8表达增强,死亡率增大,CDK8的表达与患者的生存率和预后有直接关系;KAI1蛋白在正常宫颈组织、CIN Ⅰ、Ⅱ、Ⅲ组织、宫颈癌组织的阳性表达率分别为100％、68．00％、53．00％、40．00％、16．67％;KAI1在宫颈癌组织中的表达均与年龄、组织分型、临床分期、分化程度、淋巴结转移无关（P＞0．05）,表明KAI1尚未发现与宫颈癌预后相关。结论 CDK8表达与患者的生存率和预后有直接关系,可作为宫颈癌预后的一项指标,而KAI1蛋白的表达尚未发现与宫颈癌预后相关,需后续研究确认。     

Survivin、Ki67和P63在宫颈上皮内瘤变及宫颈癌中的表达及临床意义

目的探讨Survivin、Ki67和P63在宫颈上皮内瘤变（CIN）及宫颈癌中的表达及临床意义。方法采用免疫组化PV-9000二步法检测Survivin、Ki67和P63在20例正常宫颈组织、30例CIN、50例宫颈鳞癌中的表达情况及三者间的相关性。结果正常宫颈组织、ClN及宫颈鳞癌组织中Survivin、Ki67与P63三者阳性表达率均随病变程度加重而逐渐升高（P均〈0.05）。在宫颈癌中,Survivin阳性表达与临床分期及淋巴结转移呈正相关;Ki67阳性表达仅与临床分期呈正相关;P63阳性表达仅与组织学分级相关;宫颈鳞癌组织中Ki67与P63、Survivin的表达均密切相关（P均〈0.01）。结论 Survivin、Ki67及P63联合检测可作为早期诊断CIN及宫颈癌的标记物,可提高宫颈癌的早期诊断率,对预后起到重要作用。     

宫颈环扎术治疗宫颈机能不全60例疗效观察

目的探讨宫颈环扎术治疗妊娠期宫颈机能不全的疗效。方法对60例孕妇合并宫颈机能不全者,36例施行宫颈环扎术治疗,观察妊娠结局。结果孕妇手术36例中,延长妊娠至足月28例,早产4例,流产4例,胎儿成活32例,与非手术组比较有显著性差异（P〈0.01）。结论宫颈机能不全行宫颈环扎术可以延长孕妇的孕周,改善妊娠结局。     

Life style, environmental and genetic susceptibility to cervical cancer

We have studied cervical cancer (CC) patients from Venezuela and the US to elucidate the contribution of certain acquired and genetic susceptibility factors to the development of the disease. For acquired susceptibility factors, infection with high risk human papilloma virus (HPV), having multiple sex partners and having early sexual activities are significant risk factors for CC in Venezuela. The latter two are not significant risk factors for the US population. Infection with high risk HPV is a more significant risk factor for the US than the Venezuela populations. On the other hand, cigarette smoking is significantly associated with CC in the US but not the Venezuela populations. From genetic susceptibility factors, polymorphisms in the CYP2E1 and mEH genes are not associated with CC but the GSTM1 null genotype is for the US population. Our study indicates that the same susceptibility factors can have very different roles in the development of the same disease such as CC in different countries. The information is useful for the development of effective but different disease prevention programs for different countries in the control of CC.     

脆性组氨酸三联体基因及突变型p53基因在子宫颈癌组织中表达的关联性

目的 探讨脆性组氨酸三联体基因(FHIT)、突变型p53基因在宫颈癌前病变、子宫颈癌组织中的表达及相关性,进一步分析FHIT对子宫颈癌早期诊断、治疗的意义.方法 在20例正常宫颈组织(对照组);10例CIN Ⅰ级、20例CINⅡ级、20例CINⅢ级宫颈组织;70例宫颈癌组织中采用免疫组织化学SP法检测FHIT、p53的表达.结果 FHIT表达阳性:正常宫颈组20例,为100％ (20/20);CIN Ⅰ组6例,为60％( 6/10);CINⅡ组8例,为40％( 8/20);CINⅢ组5例,为25％ (5/20);宫颈癌组2例,为3％(2/70);各组间阳性率差异有统计学意义(P＜0.05).p53表达阳性:正常宫颈组0例,为0％(0/20);CIN Ⅰ组2例,为20％(2/10);CINⅡ组7例,为35％ (7/20);CINⅢ组11例,为55％(11/20);宫颈癌组49例,为70％(49/70),各组间阳性率差异有统计学意义(P＜0.05).宫颈CIN和宫颈癌之间,FHIT和p53的表达呈负相关(P＜0.05).结论 FHIT的缺失和p53的过度表达是宫颈癌的早期、频发事件,在宫颈癌的发生、发展中呈负相关,FHIT可作为高危型CIN的筛查,为宫颈癌的基因治疗提供依据.     

颈丛阻滞配合颈椎牵引治疗神经根型颈椎病疗效观察

目的：观察颈丛阻滞配合颈椎牵引治疗神经根型颈椎病的临床疗效。方法将纳入观察的60例神经根型颈椎病患者用抛硬币法随机分为两组,甲组（n＝32）行颈丛阻滞配合颈椎牵引治疗,乙组（n＝28）采用单纯颈椎牵引治疗,根据疼痛程度评分对比分析两组的治疗效果。结果甲组治疗后10 d、20 d、30 d、90 d疼痛程度评分分别为（4．61＆#177;0．70）分、（3．71＆#177;0．57）分、（3．30＆#177;0．65）分、（4．44＆#177;1．04）分,乙组分别为（5．88＆#177;1．47）分、（5．61＆#177;1．35）分、（4．83＆#177;0．86）分、（5．50＆#177;0．87）分,组间比较差异均有统计学意义（t＝5.85、1．06、1．30、7．51,均P＜0．01）。结论颈丛阻滞配合颈椎牵引治疗神经根型颈椎病的疗效优于单纯颈椎牵引,适于在基层医疗单位推广。     

紧急宫颈环扎术治疗宫颈机能不全致宫颈扩张临床分析

目的探讨对宫颈机能不全导致宫颈扩张的孕产妇行紧急宫颈环扎术对分娩结局及胎儿存活率的临床疗效与意义。方法选择我院产科宫颈机能不全导致宫颈扩张产妇124例随机分为A、B两组。A组患者使用宫缩抑制药物进行保守治疗;B组在A组基础上联合紧急宫颈环扎术治疗。比较两组患者不同方法治疗后分娩时间、分娩方式及胎儿阿氏评分等相关指标。结果联合紧急宫颈环扎术手术B组患者足月生产人数显著多于保守治疗A组,分娩时未到足月患者人数显著少于A组(P<0.05),B组术后自然分娩人数51例,胎儿阿氏评分(8.6±0.41)分均显著高于保守治疗A组32例,(6.3±0.40)分(P<0.05)。结论对由于宫颈机能不全导致宫颈扩张的产妇行紧急宫颈环扎术能够可显著减少宫缩次数,延长胎龄,帮助胎儿在母体内进行更好的生长发育;对改善分娩结局,提高新生儿存活率具有重要意义。     

宫颈上皮内瘤变及宫颈癌272例临床分析

目的通过分析272例宫颈病变患者的临床资料,探讨宫颈病变的诊断及治疗方法。方法回顾分析CIN2/3级178例及宫颈癌94例,对比年龄、临床表现、症状、组织病理结果及治疗方法。结果 CIN2/3级年龄峰值为30～50岁,有阴道出血表现者71例(39.9%)宫颈癌的年龄峰值后移至40岁以上,有阴道出血表现者68例(72.3%)。CIN患者术前术后病理结果完全诊断一致者122例(68.5%),遗漏15例(8.4%)宫颈浸润癌。125例CIN2/3行宫颈锥切术,CIN2和CIN3的切缘阳性率分别为6.45%(2/31)和24.47%(23/94),18例宫颈锥切术后行全子宫切除标本发现CIN残留3例。结论对宫颈癌患者的筛查应根据性生活情况提前到30岁以前,对阴道出血及宫颈糜烂患者要高度重视,阴道镜活检有助于早期诊断,但也存在一定漏诊率。宫颈锥切术可作为CIN2/3患者的首选治疗方法。     

宫颈机能不全患者给予预防性宫颈环扎术的可行性

目的探讨宫颈机能不全患者给予预防性宫颈环扎术的可行性。方法回顾性分析2016年8月～2017年9月于我院就诊的宫颈机能不全患者病例49例,根据其治疗术式的不同将所有患者分为预防组(n=24)及治疗组(n=25),其中预防组给予预防性宫颈环扎术,而治疗组给予治疗性宫颈环扎术,比较两组患者环扎成功率、手术一般情况、娩出胎儿情况和术后并发症之间的差异。结果预防组环扎成功率高于治疗组(95.83%vs 68.00%)(P 0.05);两组患者住院时间无显著差异,预防组手术时间短于治疗组,分娩时机、术后延长妊娠时间长于治疗组(P 0.05);预防组足月生产率、胎儿体重和Apgar评分高于治疗组(P 0.05);预防组并发症发生率低于治疗组(37.50%vs 72.00%)(P 0.05)。结论宫颈机能不全患者行预防性宫颈环扎术成功率较高,能明显改善患者妊娠情况,优化胎儿娩出后情况,且并发症发生率较低。