p53蛋白在慢性宫颈炎及宫颈癌中的表达

采用免疫组织化学ＳＰ法分别对５７例宫颈癌、８例慢性宫颈炎Ｐ５３蛋白表达情况进行了检测，并以１１例正常宫颈鳞状上皮组织作对照。结果：Ｐ５３蛋白在宫颈癌、慢性宫颈炎中的表达率分别为７８．９％、３７．５％。正常对照均为阴性。Ｐ５３蛋白的表达率在宫颈癌病理Ⅲ级中明显高于病理Ⅰ、Ⅱ级；在溃疡型中的表达率明显低于菜花型、结节型。提示：Ｐ５３蛋白在慢性宫颈炎中的表达与细胞增殖率升高有关；Ｐ５３蛋白的表达率不仅与     

肾母细胞瘤P53基因的免疫组化研究

为了解Ｐ５３基因在肾母细胞瘤中的表达，采用ＡＢＣ免疫组织化学方法，对５６例肾母细胞瘤石蜡包埋的标本进行检测。结果：５６例肾母细胞瘤标本中１３例Ｐ５３蛋白表达阳性，预后不良组织类型Ｐ５３蛋白是性率，显著高于预后好级组织类型；有转移肿瘤Ｐ５３蛋白表达阳性率显著高于无转移肿瘤。     

肾细胞癌增殖细胞核抗原P53蛋白的表达及意义

采用免疫组织化学ＬＳＡＢ法，对５４例肾细胞癌作了增殖细胞核抗原（ＰＣＡＮ）和Ｐ５３蛋白表达的研究。结果表明：ＰＣＮＡ阳性反应计算出的增殖指数（ＰＩ）在肾细胞癌Ⅰ、Ⅱ级与Ⅲ、Ⅳ级之间有显著性差异；Ｐ５３蛋白阳性１０例（１８．３％），而正常对照组无１例阳性；ＰＣＮＡ所表示的ＰＩ与Ｐ５３蛋白阳性表达呈正相关，认为ＰＣＮＡ的表达是评估肾细胞癌预后的有用指标，Ｐ５３蛋白可作为肾细胞癌的一个恶性依据。     

滋养细胞肿瘤P53基因蛋白的检测

本文通过免疫组织化学技术对３８例滋养细胞肿瘤组织Ｐ５３基因蛋白进行了检测，试图探讨Ｐ５３基因与滋养细胞肿瘤的关系。结果３８例滋养细胞肿瘤中（葡萄胎１０例、恶性葡萄胎１０例、绒癌１８例），恶葡阳性表达２０％（２／１０），绒癌阳性表达２２．２％（４／１８），有３例为高表达，１０例良性葡萄胎均为阴性。结果提示：Ｐ５３基因与滋养细胞肿瘤的生物学行为有密切关系。随着临床的进展，高表达增加。Ｐ５３的检测可望成     

P16、P53蛋白表达与人卵巢浆液性囊腺癌的关系

采用免疫组织化学ＡＢＣ法检测了４０例人卵巢浆液性囊腺癌、１０例浆液性囊腺瘤组织中的肿瘤相关基因Ｐ１６、Ｐ５３蛋白表达。结果：Ｐ１６蛋白表达阳性率在肿瘤分化Ⅰ、Ⅱ、Ⅲ级中，分别为１６．６７％、３３．３３％和５２．６３％。４０例浆液性囊腺癌Ｐ１６蛋白表达均为阴性。Ｐ１６蛋白阳性表达与肿瘤组织学分级无明显关系（Ｐ＞０．０５）。４０例同组病例中，Ｐ５３蛋白总阳性表达率为６０％，１０例浆液性囊腺瘤Ｐ５３蛋白均呈阴性表达。低分化浆液性囊腺癌的Ｐ５３阳性表达率（７５％），高于肿瘤分化高者（３５．７１％）。两者差异有显著性（Ｐ＜０．０５）。Ⅰ与Ⅱ、Ⅱ与Ⅲ级肿瘤间，Ｐ５３蛋白总阳性表达率高于Ｐ１６蛋白的阳性表达率     

P53基因表达对大肠癌的诊断价值

目的：探讨Ｐ５３ 基因表达与大肠癌临床病理之间的关系；方法：应用ＳＰ免疫组织化学方法检测了５３ 例大肠癌标本。结果：Ｐ５３ 阳性表达与患者年龄、肿瘤部位和大小及分化程度无关（Ｐ＜ ０．０５），而与肿瘤浸润深度、淋巴结转移显著相关（Ｐ＜ ０．０１）。结论：Ｐ５３基因表达的肿瘤浸润程度重，易发生淋巴结转移。     

P53蛋白在皮肤基底细胞癌中的表达

（１）目的 探讨Ｐ５３蛋白表达与皮肤基底细胞癌的临床及组织学特征之间的关系，以期阐明皮肤基底细胞癌的发病机制，为临床诊疗提供理论依据。（２）方法 ４２例经常规石蜡包埋皮肤基底细胞癌标本，镜检确定组织学类型，应用免疫组织化学Ｓ－Ｐ法检测Ｐ５３蛋白表达。（３）结果 ４２例皮肤基底细胞癌中，１８例Ｐ５３蛋白表达阳性，阳性表达率为４２．８５％；９例强阳性，强阳性表达率为２１．４０％。Ｐ５３蛋白表达与皮肤基     

宫颈癌组织中P53蛋白过度表达的检测

应用免疫组织化学技术对１４例正常宫颈，２０例宫颈良性病变，４１例宫颈癌组织标本进行Ｐ５３蛋白过度表达的检测，以了解其与宫颈癌发生的关系。结果正常宫颈和宫颈良性病变中均无Ｐ５３蛋白过度表达，宫颈癌中Ｐ５３蛋白过度表达阳性率为２６．８％，表明Ｐ５３蛋白过度表达可能与宫颈癌的发生有关，其在宫颈癌中表达阳性率不同，表明宫颈癌的发生是多因素共同作用的结果。     

人宫颈鳞状细胞癌组织中细胞外基质金属蛋白酶诱导因子、基质金属蛋白酶-2蛋白的表达

目的：检测宫颈鳞状细胞癌组织中细胞外基质金属蛋白酶诱导因子（EMMPRIN）、基质金属蛋白酶-2（MMP-2）的表达情况,并分析其与临床病理特征的关系。方法：采用免疫组织化学SP法检测19例正常宫颈上皮组织、25例宫颈上皮内瘤样变（CIN）组织（CINⅠ级6例,CINⅡ级9例,CINⅢ级10例）、61例宫颈鳞状细胞癌组织（〈40岁20例,≥40岁41例;临床分期：Ⅰ期32例,Ⅱ期29例;组织学分级：Ⅰ～Ⅱ级48例,Ⅲ级13例;有淋巴结转移25例,无淋巴结转移36例）中EMMPRIN和MMP-2蛋白的表达。结果：宫颈鳞状细胞癌及CIN组织中EMMPRIN、MMP-2蛋白的阳性表达率均高于正常宫颈上皮组织的阳性表达率（P均〈0.05）。宫颈鳞状细胞癌组织中EMMPRIN、MMP-2蛋白的阳性表达率与临床分期及淋巴结转移有关（P均〈0.05）,与患者年龄及组织学分级无关（P均〉0.05）。宫颈鳞状细胞癌组织中EMMPRIN与MMP-2蛋白的表达无相关性（P〉0.05）。结论：EMM-PRIN、MMP-2蛋白的异常表达在宫颈鳞状细胞癌的发展恶化、侵袭和转移中起重要作用。     

膀胱移行细胞癌与突变型P^53蛋白表达的研究

对５１例膀胱移行细胞癌，９例正常膀胱粘膜及８例膀胱慢性炎组织，应用抗Ｐ５３蛋白单克隆抗体进行Ｓ－Ｐ免疫组化染色。结果表明：非癌组织均无Ｐ５３蛋白阳性表达，膀胱移行细胞癌阳性表达率为４９．０２％，且随分化程度的不同，阳性表达率有差异，０～Ⅰ级癌Ｐ５３蛋白阳性表达率为１９．０５％，Ⅱ～Ⅲ级癌Ｐ５３蛋白阳性表达率为７０．００％，两者之间差异有显著性（Ｐ＜０．０５）。此外，有淋巴结转移的移行细胞癌（Ｐ５３癌基因蛋白阳性表达率为６９．５％）与无淋巴结癌转移者（Ｐ５３癌基因蛋白阳性表达率为３２．１４％）两组之间差异有高度显著性（Ｐ＜０．０１）。上述结果提示检测Ｐ５３癌基因蛋白的表达情况可能成为膀胱移行细胞癌分级、估计淋巴结转移及预后的一项重要参考指标     

3 476名已婚妇女宫颈检查和宫颈刮片结果分析

目的分析3 476名已婚妇女宫颈检查和宫颈刮片结果,了解宫颈糜烂与宫颈刮片巴氏分级的关系。方法回顾性分析该院2003～2008年行妇科检查的3 476名已婚妇女宫颈检查和宫颈刮片的结果。结果年龄与宫颈糜烂程度有关联(P0.01),≤30岁组的宫颈糜烂发病率最高(68.0%);年龄与宫颈刮片的巴氏分级有关联(P0.05),≥61岁组的巴氏分级ⅡB级及其以上发病率最高(4.9%);不同宫颈糜烂程度与宫颈刮片的巴氏分级有关联(P0.01),重度宫颈糜烂组的巴氏分级ⅡB级及其以上发病率最高(17.3%)。结论宫颈糜烂与随年龄增长患病率逐渐降低;宫颈癌发病率与年龄、宫颈糜烂程度存在正相关。积极治疗宫颈糜烂,针对高龄妇女进行定期检查,有利于早期发现宫颈癌。     

Clinical and radiographic results of cervical artificial disc arthroplasty: over three years follow-up cohort study

Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic effects of cervical disc arthroplasty in short term have been ascertained. The aim of this study is to research the data of mid-term results.Methods In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years （range from 29 to 73）. The median follow-up was 41.85months （range from 36.00-55.63 months）. Patients were followed prospectively with respect to their symptoms,neurologic signs, and radiographic results.Results The median value of Japanese Orthopaedic Association （JOA） score was 14.0 before surgery, and 16.5 at the most recent follow-up （P 〈0.01）. The median value of the recovery rate of the JOA score was 92.2%. The preoperative range of motion （ROM） at the indexed level was （10.40±4.97）°, which has significantly correlated with the most recent follow-up ROM which was （8.56±4.76）° （P 〈0.05, r=0.33）. The ROM at the operative level at the most recent follow-upwas greater than the value at the 3-month follow-up of （7.52±3.37）° （P 〈0.05）. The preoperative functional spinal unit （FSU） angulation was （-0.96±6.52）°, which was not significantly correlated with that of the most recent follow-up value of （-2.65±7.95）° （P 〈0.01, r=0.53）. The preoperative endplate angulation was （2.61±4.85）°, which had no significant correlation with that of the most recent follow-up value of （0.71±6.41）° （p 〉0.05）.Conclusions The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well preserved.     

COA: Bryan人工椎间盘置换术3年以上随访的临床效果

背景：颈椎人工间盘置换术作为一种新的技术,近年来在脊柱外科领域广泛应用。它具有保留手术节段活动,保留置换节段的生物力学环境,减少临近节段退变等优点。尽管颈椎人工间盘置换的短期临床效果已经得到了肯定,但是中期的临床效果尚缺乏报道。 材料与方法：对2003年12月到2006年1月行颈椎人工间盘置换术的50例患者进行了随访。其中单节段颈椎人工间盘置换39例,双节段颈椎人工间盘置换11例。随访时年龄29-73岁（平均年龄50.9岁）。随访时间36.0-55.63个月,呈偏态分布,中位数为41.85个月,四分位数间距为8.71个月。。记录患者症状、神经系统体征及影像学情况。 结果：JOA评分中位数术前为14.0,末次随访时为16.5,两者间差异有统计学意义（P<0.01）,JOA评分改善率中位数为92.17%。末次随访置换节段过屈过伸活动度8.56°±4.76°与术前置换节段过屈过伸活动度10.4°±4.97°呈正相关并有统计学意义（P<0.05,r=0.33）。末次随访时置换节段活动度与术后三个月7.52°±3.37°相比略有增加,并有统计学意义（P<0.05）。术前中立位置换节段的曲度-0.96°±6.52°与末次随访时中立位置换节段的曲度-2.65°±7.95°有相关性（r=0.53,P<0.01）,差异无统计学意义（P>0.05）。术前中立位置换节段的终板间夹角为2.61°±4.85°与末次随访时置换节段的中立位假体终板间夹角0.71°±6.41°无相关性,差异无统计学意义（P>0.05）。 结论：Bryan人工间盘置换术3年随访的疗效是满意的,颈椎置换节段的生理运动范围及生物力学环境得到了较好的保持。     

颈神经及其相关结构的应用解剖

对第１、２颈神经、整个颈神经后支及相关结构（包括特殊颈椎、神经通道）作详细的调查、测量和追踪。横行分离每一块椎骨，纵行剖开每一椎体和椎弓。阐明了环椎、枢椎的解剖特点和第１、２颈神经的特殊通道结构。用解剖学观点解释了颈椎病神经根症状的临床表现和颈病机理。     

宫颈糜烂267例肉眼所见与病理诊断结果对比分析

目的 调查普通妇科医生临床肉眼拟诊的宫颈糜烂经组织学检查确诊后的疾病构成。方法 对普通妇科医生临床肉眼拟诊宫颈糜烂的患者267例行阴道镜下活检病理检查明确诊断，根据确诊结果统计其疾病构成。结果 此267例肉眼拟诊的宫颈糜烂的疾病构成为：宫颈炎28．1％（75例），宫颈上皮内瘤样病变（CIN）Ⅰ39．0％（104例），CINⅡ13．5％（36例），CINⅢ14．6％（39例），宫颈癌3．4％（9例），其他1.5％（4例）。结论 肉眼拟诊的宫颈糜烂中宫颈病变的比例很高，仅凭肉眼观察无法区分宫颈糜烂与宫颈上皮内瘤变及旱期宫颈癌。     

宫颈机能不全患者孕期腹腔镜和经阴道宫颈环扎术后的疗效分析

目的：探讨子宫颈机能不全（cervical incompetence,CI）患者孕期行腹腔镜子宫颈环扎术（laparoscopic cervical cerclage,LAC）和经阴道子宫颈环扎术（transvaginal cervical cerclage,TVC）后的妊娠结局及超声监测妊娠期子宫颈长度的变化,进一步探讨LAC的适应证。方法：回顾性分析2016年6月至2022年2月因CI孕期在本院行子宫颈环扎术的患者共115例,其中行LAC 65例（LAC组）,既往TVC失败35例,既往行子宫颈锥切术30例;TVC 50例（TVC组）,均无既往TVC失败史,既往行子宫颈锥切术20例。对2组患者的妊娠结局、术中情况、术后并发症及妊娠期超声测量的子宫颈长度进行比较。结果：LAC组既往TVC失败率高于TVC组（53.8%vs. 0.0%,P<0.05）,差异有统计学意义,LAC组、TVC组既往子宫颈锥切手术率差异无统计学意义（46.1%vs. 40.0%,P>0.05）;LAC组的足月产率、新生儿存活率、分娩孕周、延长孕周[83.0%、100.0%、（36.5±4.0）周、（1...     

颈椎前路减压颈椎椎体间融合器椎体间融合术

目的：观察颈椎椎体间融合器（ＢＡＫ）用于颈椎前路减压后椎体间固定和融合效果。方法：采用ＢＡＫ行颈椎病及颈椎间盘突出症前路减压术后椎体间融合术６４例。术后颈椎Ｘ线片及ＣＴ检查,观察手术椎节的稳定性和融合情况。结果：随访６￣２８个月,术后次日即下床活动,手术节段稳定,术后３￣６个月融合。结论：ＢＡＫ颈椎椎体间固定融合技术使施术椎节立即稳定,手术安全简便,并且避免了自体植骨引起的多种并发症,可作为替代传     

Application of cervical arthroplasty with Bryan cervical disc: long-term X-ray and magnetic resonance imaging follow-up results

Background Cervical disc arthroplasty is a new technique for treating degenerative cervical disease. Its goal is to avoid the degeneration of adjacent levels by preserving motion at the treated level. The aims of this study were to evaluate the radiologic outcomes of Bryan cervical disc replacement and the degenerative status of adjacent segments.Methods Twenty-two patients at a single center underwent discectomy and implantation of Bryan cervical disc. The mean follow-up period was 60 months （57-69 months）. Twenty patients underwent single-level arthroplasty and two underwent arthroplasty at two levels. The levels of surgery included C3/4 （3 levels）, C4/5 （2 levels）, C5/6 （18 levels） and C6/7 （1 level）. Radiographic evaluation included dynamic X-ray examination and magnetic resonance imaging （MRI） at baseline and at final follow-up.Results On X-ray examination, the range of motion （ROM） at the operated level was 7.2° （2.5°-13.0°） at baseline and 7.8° （1.0°-15.0°） at final follow-up （P 〉0.05）. Heterotopic ossification around the prosthesis was observed in eight levels,and two levels showed loss of motion （ROM 〈2°）. MRI showed worsening by a grade at the upper level in 2/22 patients,and worsening by a grade at the lower level in 3/22, according to Miyazaki＇s classification. No further impingement of the ligamentum flavum into the spinal canal was observed at adjacent levels, though the disc bulge was slightly increased at both the adjacent upper and lower levels at final follow-up.Conclusions Arthroplasty using Bryan cervical disc prosthesis resulted in favorable radiologic outcomes in this study.Disc degeneration at adjacent levels may be postponed by this technique.     

Follow-up Study on the Motion Range after Treatment of Degenerative Disc Disease with the Bryan Cervical Disc Prosthesis

This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients' ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months (with a mean of 5.2 months). Of them 5 had cervical spondylotic myelopathy and 7 had cer- vical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases re- ceived two-level replacement. Operation time of the single-level surgery averaged 130±50 min and the time of two-level surgery was 165±53 min on average (from skin incision to skin suturing). Neurological or vascular complications during or after surgery was not observed. Japanese Orthope- dic Association scores (JOA scores) increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially re- stored, being 4.68° (3.6°-6.1°) in flexion and extension position and 3.51° (2.5°-4.6°), 3.42° (2.6° -4.3°) in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm) in 2 of 14 levels and between 1.5 mm and 3 mm) in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recov- ery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.     

颈椎间盘突出症的诊断与手术治疗

目的：探讨颈椎间盘突出症的诊断和手术疗法。方法：分析颈椎间盘突出症１５６例临床资料，观察其临床表现，影响学改变及手术疗效。结果：颈椎间盘突出可分为中央型和侧方型。前者以颈髓受压，后者以神经根受损为主要临床表现，ＭＲＩ可明确显示其类型，对１４２例进行术后随访８～８８个月（平均４２个月），术后优良率为９２％（１３０／１４２）结论：ＭＲＩ对本病的诊断具有重要价值，对病情较重，尤其中央型突出者及经正规非手