鼻内窥镜下结合鼻腔解剖手术治疗鼻腔内翻性乳头状瘤

目的　探讨鼻内窥镜下结合鼻腔解剖手术治疗鼻腔鼻窦内翻性乳头状瘤的应用价值并分析其手术治疗效果。 方法　对26例鼻腔鼻窦内翻性乳头状瘤经鼻内窥镜手术的患者进行回顾性分析,根据其病变范围,按照Krouse分期法：其中Ⅰ级5例,Ⅱ级15例,Ⅲ级6例,Ⅳ级0例。单纯鼻内窥镜手术者11例,鼻内窥镜+柯-陆氏手术者12例,鼻内窥镜+鼻侧切开+柯-陆氏手术者3例。 结果　26例术后患者随访,有3例复发,再次经鼻内窥镜手术后未见复发,其余患者均未见复发,除个别患者有轻微鼻干外,其余患者无并发症出现。 结论　对Ⅰ级内翻性乳头状瘤患者,单纯鼻内窥镜手术即能彻底切除,对Ⅱ级、Ⅲ级患者需鼻内窥镜结合柯-陆氏手术,个别还需结合鼻侧切开术,术前须对病情作出正确的评估,鼻内窥镜手术视野清晰、创伤小、对于Ⅰ、Ⅱ及Ⅲ级内翻性乳头状瘤患者可彻底切除肿瘤,降低复发率。     

鼻内镜联合柯陆式术切除鼻内翻性乳头状瘤11例

目的：探讨鼻腔鼻窦内翻性乳头状瘤的外科治疗方法.方法：采用鼻内镜及柯-陆式联合手术,治疗鼻腔鼻窦内翻性乳头状瘤患者11例,其中Krouse临床分级Ⅱ级4例,Ⅲ级7例.结果：术后随访1～3 a.11例中,9例痊愈,局部复发1例,癌变（鳞癌）1例.结论：鼻内镜联合柯-陆术式切除鼻腔鼻窦内翻性乳头状瘤,具有手术创伤小、术野清晰、肿瘤切除彻底等优点;对于Krouse分级为Ⅱ、Ⅲ级的鼻内翻性乳头状瘤患者,建议首选该术式.     

鼻内镜下鼻-鼻窦内翻性乳头状瘤手术疗效分析

目的 评价鼻内镜下各种手术方法治疗鼻-鼻窦内翻性乳头状瘤(IP)的效果.方法 回顾性分析58例有完整随访资料的经鼻内镜手术治疗的鼻-鼻窦IP患者,统计分析不同患者类型、Krouse分期或手术方法的复发率.结果 随访(68±3)个月,6例术后复发.其中初发和复发患者的复发率分别为9.8%(4/41)、11.8%(2,17);Krouse分期Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期患者的复发率分别为11.1%(1,9)、6.7%(2,30)、6.7%(1/15)和50.0%(2/4);单纯鼻内镜、鼻内镜辅助柯一陆手术进路术与鼻内镜辅助鼻侧切开进路术复发率分别为15.6%(5/32)、4.2%(1/24)和O(O/2).不同患者类型、Krouse分期或手术方法的复发率比较差异均无统计学意义(均P＞0.05).结论 经鼻内镜手术治疗鼻-鼻窦IP安全、有效、微创,根据不同患者类型以及分期采用不同的内镜手术方法是治疗成功的关键.     

鼻内镜下鼻-鼻窦内翻性乳头状瘤手术疗效分析

Objective To evaluate the efficacy of various nasal endoscopic surgery for sinonasal inverted papilloma (SIP).Methods Complete follow-up data of 58 cases of sinonasal inverted papilloma were retrospectively analyzed.Patient types as well as Krouse staging and rates of recurrence with various surgery were statistically analyzed.Results During the follow-up for (68±3) months, SIP recurred in 6 cases.The rate of recurrence was 9.8% (4/41) in cases with primary diagnosis vs 11.8% (2/17) in those with relapsing tumors, respectively.Recurrence rates with stages Ⅰ , Ⅱ , Ⅲ and Ⅳ tumors were 11.1% (1/9),6.7% (2/30), 6.7% (1/15) and 50.0% (2/4) respectively.For simple nasal endoscopic surgery, endoscopyassisted Caldwell-Luc's surgery, and endoscopy-assisted lateral rhinotomy, the recurrence rates were 15.6% (5/32) , 4.2% (1/24) and 0 (0/2), respectively.There was no significant difference among patient types,Krouse staging or surgical methods.Conclusions Nasal endoscopic surgery is a safe, effective and minimally invasive method for sinonasal inverted papilloma.Selection of endoscopic surgery according to patient type and stage is critical for a successful treatment.     

人乳头状瘤病毒感染及感染拷贝数与食管癌的关系

人乳头状瘤病毒感染及感染拷贝数与食管癌的关系吕丽春沈忠英游绍进沈健蔡唯佳一、材料和方法收集１９９４年～１９９５年我院附属医院外科手术切除、病理确诊的新鲜食管癌标本５５例，每例分别取癌组织、癌旁粘膜和远端切缘粘膜３部分，经ＯＣＴ包埋在一起，常规冰冻切片...     

厦门地区女性人乳头瘤病毒感染状况调查

目的 对厦门地区妇女宫颈人类乳头瘤病毒（human papilloma virus,HPV）亚型进行筛查,以探讨其分布规律.方法 采用凯普医用核酸分子快速杂交仪,对7683名2013年1月-2013年12月到厦门市174医院妇科门诊或病房就诊的女性进行生殖道21种HPV感染基因亚型筛查.结果 7683例样本中,HPV感染者1421例,阳性率18.50％.感染人群主要集中在30～39岁.其中高危型HPV阳性率为16.01％,低危型HPV阳性率为2.49％.单一基因型别者1148例,阳性率为14.94％;双重感染者220例阳性率为2.86％;三重以上感染者53例,阳性率为0.70％;HPV感染阳性率居前6位的基因型分别为HPV-52（3.64％）、HPV-16 （3.33％）、HPV-58（2.98％）、HPV-53（2.16％）、HPV-CP8304（1.91％）和HPV-18（1.09％）.结论 厦门地区妇女HPV感染率高,且以高危型单一基因亚型感染为主;感染基因型别主要以HPV-52、16、58、53、CP8304和18为主,具有一定的地域差异性;52及58型感染率高,对于疫苗的研制和开发有参考意义.     

机体对人乳头状瘤病毒感染的免疫反应研究进展

机体可对人乳头状瘤病毒蛋白或病毒样粒子产生抗体，表皮细胞可产生多种细胞因子参与对病毒的非特异性细胞免疫反应，而机体对人乳头状瘤病毒的特异性细胞免疫反应要经过识别和效应阶段，人乳头状瘤病毒通过几个可能的机制逃逸机体的免疫反应。     

人乳头状瘤病毒感染的病理生理与机体免疫

人乳头状瘤病毒(Human Papillamaviruses,HPV)为环状DNA病毒,编码11种功能不同的基因产物,在病毒复制、感染机体及致病过程中起不同作用.HPV与人类许多疾病有关,其致病过程涉及病毒基因组的整合、病毒基因的激活,通过干扰宿主细胞的信号转导等途径,导致宿主细胞的异常增殖和恶变.HPV感染机体后可导致体液及细胞免疫应答等病理生理改变.     

外阴上皮内瘤变与人乳头状瘤病毒感染的相关性

目的 探讨人乳头状瘤病毒(HPV)在外阴上皮内瘤变(VIN)中的感染情况及与p53、Ki-67蛋白表达的关系.方法 用原位杂交法(ISH)检测HPV6/11、16/18、31/33型在55例VIN及10例外阴正常皮肤组织中的表达.同时用免疫组化SP法检测p53、Ki-67蛋白的表达.结果 HPVl6/18、31/33、6/11在VINⅢ中的阳性表达率分别为60%(6/10)、20%(2/10)和0%(0/10);在VIN Ⅱ中为53.57%(15/28)、39.28%(11/28)和10.71%(3/28);在VIN Ⅰ中为17.65%(3/17)、5.88%(1/17)和29.41%(5/17);正常对照组没有表达.p53、Ki-67蛋白在VINHI中的阳性表达率分别为70%(7/10)和90%(9/10);在VINⅡ中为78.57%(22/28)和78.57%(22/28);在VIN Ⅰ中为64.71%(11/17)和35.29%(6/17);在正常对照组没有表达.经统计学分析,VINⅢ、Ⅱ组中的HPVl6/18感染与正常组差异有显著性(P＜0.05);VINⅡ组的HPV31/33感染与正常组差异有显著性(P＜0.05);VINⅢ、Ⅱ组p53、Ki-67及VIN Ⅰ组p53阳性表达率与正常组差异有显著性(P＜0.05);VIN Ⅰ组Ki-67阳性表达率与VINⅡ组相比差异有显著性(P＜0.05).结论 VIN的发生与HPV感染有关,尤其与HPVl6/18、31/33型感染密切相关.VIN与外阴癌感染的HPV型别相同.在VIN的发生发展中,HPV感染以及p53突变可能起重要的作用.     

人乳头状瘤病毒感染与宫颈癌前病变的关系

目的 探讨人乳头状瘤毒（ＨＰＶ）感染与宫颈湿疣、癌前病变的相关性。方法 对１７９例宫颈细胞涂片异常患者行宫颈多点活检,病理形这观察,其中１２８例同时采用ＰＣＲ方法检测ＨＰＶ－ＤＮＡ,１０例行原位杂交分析。结果（１）形态学观察：宫颈湿疣多为扁平型（９７．３％）;除表现经典的诊断性控空细胞（３９．７％）外,国可见异型性明显的非典型性控空细胞（６０．３％）;宫颈湿疣常伴宫颈上皮内肿瘤（ＣＩＮ,４２．５％     

Human papillomavirus infection and the malignant transformation of sinonasal inverted papilloma: A meta-analysis

A growing number of molecular epidemiological studies have been conducted to evaluate the association between human papillomavirus (HPV) infection and the malignancy of sinonasal inverted papilloma (SNIP). However, the results remain inconclusive. Here, a meta-analysis was conducted to quantitatively assess this association. Case-control studies investigating SNIP tissues for presence of HPV DNA were identified. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by the Mantel-Haenszel method. An assessment of publication bias and sensitivity analysis were also performed. We calculated a pooled OR of 2.16 (95% CI = 1.46–3.21, P < 0.001) without statistically significant heterogeneity or publication bias. Stratification by HPV type showed a stronger association for patients with high-risk HPV (hrHPV) types, HPV-16, HPV-18, and HPV-16/18 infection (OR = 8.8 [95% CI: 4.73–16.38], 8.04 [95% CI: 3.34–19.39], 18.57 [95% CI: 4.56–75.70], and 26.24 [4.35–158.47], respectively). When only using PCR studies, pooled ORs for patients with hrHPV, HPV-16, and HPV18 infection still reached statistical significance. However, Egger’s test reflected significant publication bias in the HPV-16 sub-analysis (P = 0.06), and the adjusted OR was no longer statistically significant (OR = 1.65, 95%CI: 0.58–4.63). These results suggest that HPV infection, especially hrHPV (HPV-18), is significantly associated with malignant SNIP.     

Demonstration of secretory component, IgA, and IgM by the peroxidase-antiperoxidase technique in inverted papillomas of the nasal cavities

Fifteen inverted papillomas were examined by the peroxidase-antiperoxidase method for their ability to synthesize secretory component (SC) and to take up IgA and IgM. In each case, SC and IgA could be localized to the apical cytoplasm of some tumor cells. In addition, secretory component, IgA, and IgM were observed as the main constituents of hyaline globules lying in the intracytoplasmic lumina of one columnar cell variant of inverted papilloma, suggesting an intact transepithelial transport mechanism of polymeric immunoglobulins. Goblet cells, found only in the transitional cell variant of inverted papilloma, did not react with anti-SC, anti-IgA, or anti-IgM. Since SC can be utilized as a marker to differentiate columnar cells from goblet cells, transitional cell papillomas may originate from undifferentiated reserve cells, which retain their capacity to differentiate into both columnar cells and goblet cells. In contrast, in columnar cell papillomas only differentiated columnar cells are integrated into the neoplastic process.     

头部CT三维重建在鼻窦内翻性乳头状瘤术前规划的应用

目的　通过基于头部CT的三维重建技术,对复杂的内翻性乳头状瘤进行手术规划,为临床推广应用提供参考。　方法　本实验选取一名男性患者,65岁,体重70 kg,身高170 cm,无头部外伤史、手术史、颅脑疾病家族史。行头部CT平扫,排除脑组织器质性疾病。已和患者签署知情同意书。将头部CT图像通过逆向工程软件Mimics 15.0建立三维立体模型,将手术仿真成功的三维模型组件在3-Matic 7.0进行测量,对鼻窦内翻性乳头状瘤患者进行手术规划设计及术后随访观察。　结果　建立了与CT图像测量结果一致的颅骨、鼻窦及肿瘤的三维立体模型;建立了与手术入路一致的仿真鼻部通道的三维模型;确定了复杂鼻部肿瘤的手术方案及预后评估。术中切除肿瘤组织测量结果为X轴最大值为64.78 mm,Y轴71.21 mm,Z轴86.46 mm,总体积为58.88 ml,其形态、大小与术前三维重建测量分析结果基本一致。　结论　根据三维立体模型分析得出的数据设计手术方案,有助于顺利完成手术,对个体化鼻窦肿瘤手术设计具有重要的临床指导意义。     

A rare case of nasal Schneiderian (inverted) papilloma associated with basaloid squamous cell carcinoma

Sinonasal inverted papilloma (IP) is a benign, locally aggressive epithelial neoplasm. In less than 9% of cases it is associated with malignancies, typically conventional squamous cell carcinomas (SCC), while other histological variants have been less frequently reported. We describe the third case of basaloid squamous cell carcinoma (BSCC) arising in nasal IP.An 81-year-old female patient presented with a pinkish irregular lesion on the nasal septum. Biopsy was consistent with IP and carcinoma in situ. Two surgical procedures were needed to obtain radical excision. Histology on the surgical specimen revealed BSCC. Seven months after surgery, there was no evidence of disease recurrence.Although IP is more frequently associated with conventional SCC, other malignancies should be considered. The histological differential diagnosis should be supported by immunohistochemistry. The generally-recommended treatment for sinonasal BSCC is complete surgical resection, although this may be a problem in multifocal distributions, as in the present case.     

Inverted papillomas of nasal cavity and paranasal sinuses

Summary 10 cases of inverted papillomas of nasal cavity and paranasal sinuses were examined electron microscopically with particular regard to the epithelial-stromal interface. The papilloma cells were clearly demarcated from the stromal tissue by a basement membrane-like material. However, this structure mainly consisted of two or more layers, occasional breaks in the basement membrane were visible. Within the basal epithelial cells resting on the basement membrane accumulations of actinlike microfilaments could sometimes be observed. Furthermore, in the stromal tissue some myofibroblasts were present in the vicinity of the papillomatous cell complexes and capillary vessels also demonstrated several layers of basement membrane. All the changes presented here are considered to be the result of a permanent interaction between aggressive forces of papilloma cells and the defence mechanism of stromal tissue. The results allow the conclusion that inverted papillomas of nasal cavity and paranasal sinuses are true neoplasms with very low malignancy.     

Human papillomavirus 6, 11, and 16 in laryngeal papillomas.

Twenty-seven cases of benign laryngeal papillomas, both single and multiple variants, were analysed for human papillomavirus (HPV) by DNA slot-blot hybridization chiefly to determine the pattern of infection in Hong Kong Chinese. DNA was extracted from paraffin blocks of formalin-fixed tissue and probed separately for HPV 6, 11, 16, and 18. Sixteen cases (59 per cent) showed the presence of at least one of these four HPV genomes. Thirteen cases (48 per cent) were positive for HPV 11 only. Three other cases (11 per cent) showed triple positivity for HPV 6, 11, and 16. None were positive for HPV 18. The predominance of HPV 11 infection contrasts with other series which have shown either an almost equal distribution of HPV 6 and 11 or a predominance of HPV 6. The finding of HPV 16 in three cases was unexpected. Using the polymerase chain reaction (PCR) with primers complementary to the upstream regulatory region of the HPV 16 viral DNA, the presence of HPV 16 genome was confirmed in all three cases. As the number of HPV 16-positive cases in this study is small, analysis of more cases using fresh biopsy material and a wider range of HPV type-specific PCR primers is warranted to determine the relative incidence of HPV subtypes in these benign laryngeal papillomas.     

Tumor-specific and gender-specific pre-vaccination distribution of human papillomavirus types 6 and 11 in anogenital warts and laryngeal papillomas: a study on 574 tissue specimens

Anogenital warts and laryngeal papillomas are two most important benign tumors etiologically linked with HPV. In the study, which included both the largest number of laryngeal papilloma tissue specimens (152 specimens from 152 patients) to date and the largest number of prospectively collected and histologically confirmed tissue specimens of anogenital warts obtained from both genders (422 specimens from 315 patients), HPV DNA was detected in 413/422 (97.9%) of anogenital warts and 139/152 (91.4%) of laryngeal papillomas. HPV‐6 and/or HPV‐11 were detected in 291/315 (92.4%) patients with anogenital warts and in 138/152 (90.8%) patients with laryngeal papillomas, indicating that the great majority of both tumors could be prevented with prophylactic quadrivalent vaccine. The HPV‐6 gender‐specific distribution in both anogenital warts and laryngeal papillomas was not statistically significant. In contrast, HPV‐11 was found almost three times more often in males than in females with anogenital warts (16.5% vs. 6.3%; P = 0.008), with a gender neutral HPV‐11 type distribution in laryngeal papillomas. The overall HPV DNA prevalence in anogenital warts was significantly different from that in laryngeal papillomas (97.1% vs. 91.4%; P = 0.01). In the first comparison of the HPV‐6/HPV‐11 type‐specific distribution between patients suffering from anogenital warts and laryngeal papillomas with the same geographic and ethnic background, a significant imbalance in tumor‐specific distribution of HPV‐6 and HPV‐11 was identified: HPV‐6 was statistically more often present in anogenital warts than in laryngeal papillomas (79.0% vs. 59.2%; P = 0.000013), whereas HPV‐11 was statistically more frequent in laryngeal papillomas than in anogenital warts (28.9% vs. 12.4%; P = 0.00003). J. Med. Virol. 84: 1233–1241, 2012. © 2012 Wiley Periodicals, Inc.     

Etiological role of human papillomavirus infection for inverted papilloma of the bladder

The status of human papillomavirus (HPV) infection in urothelial inverted papilloma was examined in the present study. Formalin-fixed and paraffin-embedded tissues from eight cases of inverted papilloma of the bladder were studied. The presence of HPV-DNA was examined by modified GP5/6+PCR using archival tissue sections by microdissection. HPV genotype was determined with a Hybri-Max HPV genotyping kit. Immunohistochemical analysis for p16-INK4a, mcm7, HPV-E4, and L1, and in situ hybridization for the HPV genome were performed. HPV was detected in seven of eight cases (87.5%) of inverted papilloma. Three cases were diagnosed as inverted papilloma with atypia, while the remaining five were typical cases. HPV-18 was detected in two cases, including one inverted papilloma with atypia, and HPV-16 was detected in four cases, including one inverted papilloma with atypia. Multiple HPV type infection was detected in one typical case and one atypical case. High-risk HPV was present in all HPV-positive cases. Cellular proteins, p16-INK4a and mcm7, which are surrogate markers for HPV-E7 expression, were detected in all HPV-positive cases, and their levels were higher in inverted papilloma with atypia than in typical cases. In contrast, HPV-E4 and L1, which are markers for HPV propagation, were observed in some parts of the typical inverted papilloma tissue. High-risk HPV infection may be one of the causes of urothelial inverted papilloma, and inverted papilloma with atypia may have malignant potential.     

人乳头瘤病毒感染与人乳头瘤病毒疫苗的研究进展

人乳头瘤病毒(HPV)感染与宫颈癌的发生密切相关,是宫颈癌发生的最主要诱发因素.预防性HPV疫苗是一种预防宫颈癌的新方法,其效果得到了多项临床试验的肯定.治疗性HPV疫苗的研发同样备受关注,目前治疗性疫苗的类型很多,但因其机制较复杂,大多仍处在实验阶段.