超大剂量化疗与外周血干细胞移植治疗卵巢癌

超大剂量化疗与外周血干细胞移植治疗卵巢癌刘开江崔恒钱和年卵巢癌的治疗,是目前妇科恶性肿瘤中最具挑战性的课题之一。虽然以铂类为基础的联合化疗的总有效率高达７０％～８０％。但仅有３０％～５０％达临床完全缓解,１０％～３０％达病理完全缓解［１］。耐药是化疗...     

外周血干细胞移植与高剂量化疗治疗卵巢癌

卵巢癌是妇科致死率最高的肿瘤.其治疗方法主要为肿瘤细胞减灭术和术后化疗,有效的化疗可以及早防止卵巢癌复发,提高治愈率,缓解晚期卵巢癌的症状,延长生存期.传统化疗方法因存在耐药和毒性反应而有一定局限性.外周血干细胞移植(peripheral blood stem cell transplantation,PBSCT)支持下的高剂量化疗(high-dose chemotherapy,HDC),则能明显地减少毒副反应,缩短化疗周期,近年受到广泛关注.对这一方法治疗卵巢癌的研究进展作一综述.     

外周血干细胞移植与高剂量化疗治疗卵巢癌

卵巢癌是妇科致死率最高的肿瘤。其治疗方法主要为肿瘤细胞减灭术和术后化疗,有效的化疗可以及早防止卵巢癌复发,提高治愈率,缓解晚期卵巢癌的症状,延长生存期。传统化疗方法因存在耐药和毒性反应而有一定局限性。外周血干细胞移植(peripheral blood stem cell transplantation,PBSCT)支持下的高剂量化疗(high-dose chemotherapy,HDC),则能明显地减少毒副反应,缩短化疗周期,近年受到广泛关注。对这一方法治疗卵巢癌的研究进展作一综述。     

超大剂量化学药物和外周血干细胞移植治疗晚期妇科恶性肿瘤5例分析

目的　探讨超大剂量化学药物和外周血干细胞移植治疗晚期妇科恶性肿瘤的临床疗效。方法　对 4例卵巢癌 ,1例输卵管癌 ,在肿瘤基本切净后行超大剂量化学治疗 (HDC)及外周血干细胞移植术 (PBSCT) (其中 4例为复发病例 ,1例为初治Ⅲ期卵巢癌 ) ,观察疗效及副反应发生情况。结果　 5例患者接受HDC和PBSCT治疗后 ,4例临床缓解 ,1例卵巢幼年型颗粒细胞瘤疾病进展死亡。4例患者临床无瘤缓解期平均为 9个月 ;平均存活时间 2 1个月。超HDC治疗副反应主要为骨髓严重抑制 ,外周血白细胞最低降到 0 .0 5× 10 9/L～ 0 .2× 10 9/L ;血小板降到 7× 10 9/L～ 8× 10 9/L ;粒细胞恢复到 >0 .5× 10 9/L的时间平均为 14d ;血小板恢复到 5 0× 10 9/L的时间平均为 17d。 5例患者无一例出现其他的严重并发症。结论　超HDC和PBSCT治疗晚期卵巢癌 ,虽副反应较严重 ,但严格掌握病例选择标准 ,还是安全、可行的。对于耐药复发病例的疗效 ,还有待于进一步观察。     

脐血移植治疗难治性儿童白血病

目的：研究用ＨＬＡ不合多个脐血移植治疗难治性儿童白血病。方法：选择难治性白血病患儿，给予强烈化学治疗杀灭残存白血病细胞，再用多个脐血混合移植解救处于严重抑制状态的骨髓，以缓解白血病，延长生命。结果：治疗６例，年龄２５～１６岁，均为男性。用ＶＡＣ或ＡＶ方案化疗后，约１１ｄ外周血颗粒细胞降至零。输注脐血后平均１３ｄ外周血白细胞升至１０×１０９／Ｌ，６０ｄ内骨髓象正常，全部患者达到完全缓解。随诊１～４年，３例死亡，３例分别存活３６、４４、２０个月。结论：混合脐血移植对难治性白血病有较好疗效，其治疗作用机理值得进一步探讨。     

超大剂量化学药物和外周血干细胞移植治疗晚期妇科恶性肿瘤 …

目的 探讨超大剂量化学药物和外周血干细胞移植治疗晚期妇科恶性肿瘤的临床疗产儿。方法 对４例卵巢癌,１例输卵管癌,在肿瘤基本切净后行超大剂量化学治疗（ＨＤＣ）及外周血干细胞移植术（ＰＢＳＣＴ）（其中４例为复发产两列例为初治Ⅲ期卵巢癌）,观察疗铲及副反应发生情况。结果 ５例患者接受ＨＤＣ和ＰＢＳＣＴ治疗后,４例临床缓解,１例卵巢幼年型颗粒细胞疾病进展死亡。４例患者临床无瘤缓解期平均为９个月;平均存活时     

女性血液病患者清髓性造血干细胞移植后医源性卵巢早衰激素治疗的临床研究

目的探究女性血液病患者造血干细胞移植后卵巢早衰性激素治疗（HT）的效果和安全性。方法收集北京大学人民医院血液病清髓化疗造血干细胞移植后闭经患者88例,对其原发病、移植前后月经和内分泌状态、药物治疗剂量等进行回顾性分析;并给予不同方案的性激素治疗,观察治疗后患者的症状改善、月经恢复、原发病复发和组织排异情况。结果88例术前月经正常术后闭经患者中,74例接受HT,患者平均年龄（30．1±7．3）岁（16-44岁）,其中3例局部用药,71例全身HT。在71例全身HT患者中,7例采用连续联合方案,64例采用周期序贯方案。在64例周期序贯方案患者中,38例用药1～10个月后有周期性撤退出血,15例用药12个月以上无撤退出血,11例患者用药1～6个月尚未回访。骨髓移植后使用地塞米松≥6个月（P=0．062）及环孢素A≥7个月（P=0．053）患者似乎更不易产生撤退性出血。接受HT与未使用HT患者的原发病复发（4．1％,3／74）和排异反应（5．4％,4／74）比较,差异无统计学意义（P〉0．05）。结论血液病造血干细胞移植后患者几乎100％闭经,HT是合适的补救措施,多数患者症状改善,月经周期恢复。并且HT不增加原发病复发或组织排异反应。     

小儿急性淋巴细胞白血病前期6例分析及文献复习

目的提高对小儿急性淋巴细胞白血病前期(Pre ALL)的认识。 方法对西安市儿童医院1997—2004收治的6例Pre ALL患儿的临床经过及实验室的特点进行分析,并复习相关文献。 结果男4例，女2例，年龄2岁3个月至8岁7个月，6例均有发热、贫血、出血。初诊为再生障碍性贫血(AA)5例、骨髓异常增生综合征(MDS)1例。4例出现肝、脾、淋巴结肿大(非同时)，三系细胞减少，骨髓穿刺涂片示：增生减低4例，重度减低2例；骨髓病理活检：4例均示脂肪组织增多，造血组织减少；2例出现干抽的患儿伴有纤维组织增生，2例出现病态造血。经或不经糖皮质激素治疗，在1~9个月内均转变为急性淋巴细胞白血病(ALL)。3例接受VDLP方案治疗获完全缓解。 结论6例转变为ALL,对化疗敏感，部分Pre ALL有形态学异常。     

干细胞移植治疗胎儿遗传性疾病的研究进展

胎儿是干细胞移植的最理想受体.干细胞移植治疗的成功需要有特异性分化的多能干细胞、选择干细胞移植最佳时机、有效地避免免疫排斥反应并成功诱导特异性免疫耐受、提高胎儿体内起治疗作用的移植物嵌合水平和选择恰当的候选疾病等多方面.目前,应用子宫内干细胞移植的方法已成功治疗一些造血系统、非造血系统和代谢性疾病.     

宫颈癌早期诊断4种方法的比较和意义

目的 通过比较4种常用方法，以期找到宫颈癌早期筛查的最佳方案。方法 2003年3～4月。选取华中科技大学同济医学院附属同济医院门诊阴道镜室接诊病例50例，以病理检查作为金标准，采用肉眼观测(辅以醋酸和碘试验)、阴道镜检查、液基细胞学检查(TCT)、HC-Ⅱ法HPV DNA检测等4种常用方法，对比其特异性、敏感性、准确性、约登指数及Kappa值。结果 4种检测方法敏感性、特异性、准确性、阳性预测值、阴性预测值、约登指数及Kappa值依次为：肉眼观测辅以醋酸和碘试验(33．33％、74．47％、72．00％、7．69％、94．59％、0．0780、0.0270)，阴道镜检查(33．33％、91．49％、88．00％、20．00％、95．56％、0．2482、0．1892)，液基细胞学检查(66．67％、97．87％、96．00％、66．67％、97．87％、0．8227、0．6454)，HCⅡ法HPV DNA(100％、85．11％、86．00％、30．00％、100．00％、0．8511、0．4067)。结论 肉眼观测辅以醋酸和碘试验诊断价值很低；液基细胞学检测和HC-Ⅱ法HPV DNA检测两者均为宫颈癌早期筛查的可选方法，两种方法联合应用阴性预测值高，阴道镜检测不适用于早期筛查。     

Asymptomatic vasculitis of the uterine cervix in presence of cervical intraepithelial neoplasia grade III

Case report A 34-year-old woman was diagnosed to have a high-grade cervical intraepithelial neoplasia and was treated by large loop excision of the transformation zone. Histology of the excised cone confirmed the diagnosis but also showed evidence of vasculitis of medium-sized vessels of the cervix. The woman was referred to a physician to rule out underlying systemic disease. Extensive laboratory and clinical screening was negative.Discussion The clinical significance and management of asymptomatic isolated vasculitis of the uterine cervix are discussed.     

Atypical glandular cells and adenocarcinoma in situ according to the Bethesda 2001 classification: cytohistological correlation and clinical implications

BACKGROUND: The objective of this study was to evaluate the correlation between the 2001 Bethesda classification of endocervical glandular abnormalities and histological diagnosis. STUDY DESIGN: A series of 155 women with endocervical glandular abnormalities on cervical smears were included: 91 with atypical glandular cells (AGC) not otherwise specified (NOS), 15 with AGC-favor neoplastic (FN); 35 with AGC associated with high-grade squamous intraepithelial lesion (HSIL) as combined diagnosis and 14 with adenocarcinoma in situ (AIS). RESULTS: Histological outcome of squamous neoplasias (CIN 2 or worse) and adenocarcinoma were significantly associated with AGC-FN and AIS, taking as reference AGC-NOS, and more associated with AIS than AGC-FN. Similar associations were observed for histological outcome of adenocarcinoma, but no association was observed for only squamous neoplasia. Histological outcome of CIN2 or worse was strongly associated with AGC when HSIL was also present, but no association was observed with only for adenocarcinoma histological outcome. CONCLUSIONS: AGC-NOS, AGC-FN and AIS cytological diagnosis represent a progressively increasing association with neoplastic diagnosis, due to progressively increasing association with adenocarcinoma. Histological outcome of squamous neoplasia is frequent but does not differ with these cytological interpretations. The presence of HSIL associated with AGC represents greater probability of squamous neoplasia but not adenocarcinoma.     

三阶梯技术在436例宫颈病变中的应用价值探讨

目的:探讨三阶梯技术在宫颈病变诊治中的临床应用价值。方法:对2007年1月至2008年12月在中山大学附属肿瘤医院妇科宫颈病变门诊就诊的436例患者的临床病理资料进行回顾性分析。结果:细胞学诊断为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)、不典型鳞状上皮细胞不除外高度上皮内病变(ASC-H)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、鳞癌细胞(SCC)及不典型腺细胞(AGC),经活检病理确诊宫颈上皮内瘤变Ⅱ(CINⅡ)及以上病变的比例分别为30.7%、67.5%、43.3%、89.0%、100.0%、33.3%。ASCUS的病例中50.9%经活检病理诊断为慢性宫颈炎。阴道镜检查为正常、LSIL、HSIL、浸润癌与病理诊断的符合率分别为67.3%、31.4%、79.0%、75.9%。初次阴道镜检查可能低估了32.8%(62/189)的HSIL及42.0%(34/81)的浸润癌。阴道镜下多点活检与锥切术后病理结果符合者150例(76.5%),锥切术后确诊宫颈浸润癌39例。结论:对筛查结果有异常者进行阴道镜检查,可以有效地检出宫颈病变;宫颈锥切术是治疗宫颈上皮内瘤变及进一步排除浸润癌的重要手段。     

Platelet-derived endothelial cell growth factor as a prognostic factor for radiotherapy outcome in patients with adenocarcinoma of the uterine cervix

OBJECTIVE: The aim of this study was to evaluate the platelet-derived endothelial cell growth factor (PD-ECGF) and VEGF expressions of tumor cells as prognostic factors for radiotherapy outcome in patients with adenocarcinoma of the uterine cervix. METHODS: In 47 formalin fixed, paraffin-embedded tissues from adenocarcinoma of the uterine cervix which had been treated with radiation (1970-1995), PD-ECGF and VEGF expressions were determined using immunohistochemistry, and the relationships between PD-ECGF or VEGF expressions and local control or survival were assessed. RESULTS: PD-ECGF and VEGF expressions were successfully detected in the cytoplasm and/or nucleus of adenocarcinoma cells of the uterine cervix. Of the 47 patients, 44.6 (21/47 cases) and 57.4% (27/47 cases) were positive for PD-ECGF and VEGF, respectively. There was no correlation between PD-ECGF or VEGF expressions and age, grade, or histologic subtypes. Stage and high expression of PD-ECGF showed a significant correlation to local control (P = 0.0025, P = 0.0057, respectively) and were significant independent prognostic factors for 5-year survival in multivariate analysis (P = 0.0039, P = 0.0032, respectively). CONCLUSION: This study demonstrated that PD-ECGF expression was a significant prognostic factor for radiotherapy outcome in patients with adenocarcinoma of the uterine cervix. Preradiation assessment of PD-ECGF expression may be helpful in selecting high-risk patients, providing them with opportunities to receive more sophisticated and individualized treatments.     

Pregnancy outcome in patients treated with cervical conization for cervical intraepithelial neoplasia

Objective

To examine the causal contribution of conization to premature delivery.

Methods

This was a retrospective, case-control, multicenter study of women who underwent conization in 5 hospitals in the Basque Country (Spain) from 1998 to 2007. Three study groups were established: group A, post-conization infant deliveries; control group B, pre-conization infant deliveries; and control group C, infant deliveries without conization.

Results

Comparing group A with group C, there was a higher rate of preterm delivery before 35 weeks (5.3% versus 1.6%), a lower mean birth weight (3156.2 g versus 3328.5 g), and a greater prevalence of infants under 2500 g (10.6% versus 3.7%). There were no significant differences between group A and group B: preterm delivery before 35 weeks (5.3% versus 4.8%), mean birth weight (3156.2 g versus 3119.4 g), and prevalence of infants under 2500 g (10.6% versus 10.6%).

Conclusion

Pregnancy in women post-conization was associated with a risk of preterm delivery. However, there were no significant differences between women who underwent conization before and those who underwent conization after delivery. Cervical conization does not necessarily increase the risk of preterm delivery in subsequent pregnancy. Conization should be considered an indicator of such risk because it is associated with pregnancy complications arising from socio-epidemiologic factors present in women requiring conization that are also present in women who have premature delivery.     

The prognostic implications of anaemia in the outcome of patients with early stages of uterine cervix carcinoma

 We studied the prognostic value of anaemia in the evolution of patients with early stages of uterine cervix cancer and treated with radical surgery. An observational study of 114 patients treated for cervical cancer at the ”La Fe” Maternity Hospital in Valencia (Spain) during the period 1971 to 1989. Survival analyses were carried out whereby both recurrence and mortality rates were considered. The level of haemoglobin influences the prognosis of the patients in the study presented, and explains a variation in the disease-free interval in correlation with that of tumour size. However, its influence on the survival interval proved to be somewhat less. Its predictive value is not diminished when associated with other important factors regarding the influence on patient evolution and is seen to be a protector variable against recurrence. Patients with haemoglobin levels of less than 13 gr/dl have a less favourable prognosis and this prognosis worsens still further when levels are lower than 12 gr/dl, which is more frequently the case in patients under 40 years of age and with a greater stromal invasion depth. The influence of haemoglobin levels is equally as important in its influence on prognosis and patient evolution as the volume of the tumour itself. The effect of this variable depends on both the clinical characteristics of the patients and the pathological characteristics of the tumour. Received: 17 October 2001 / Accepted: 28 December 2001     

宫颈环形电切术治疗宫颈上皮内瘤变疗效及对妊娠结局的影响

目的 探讨宫颈环形电切术（LEEP）治疗宫颈上皮内瘤变（CIN）疗效及对妊娠结局的影响。方法 选取160例CIN患者,采用随机数字表法分为研究组与对照组,每组80例。对照组实施冷刀锥切术（CKC）治疗,研究组实施宫颈环形电切术治疗。比较两组手术时间、术中出血量、创面愈合时间、术后6、12个月人乳头瘤病毒（HPV）转阴率及妊娠结局。结果 研究组手术时间、创面愈合时间均明显短于对照组,术中出血量明显少于对照组,差异有统计学意义（P<0.05）。研究组术后6、12个月HPV转阴率分别为52.50%、78.75%,均明显高于对照组的36.25%、63.75%,差异有统计学意义（P<0.05）。术后随访1年,研究组妊娠率明显高于对照组,流产、早产、剖宫产、低出生体重儿比例均明显低于对照组,差异有统计学意义（P<0.05）。结论 相比冷刀锥切术,宫颈环形电切术治疗CIN可缩短手术时间,减少术中出血量,促进术后康复,提高HPV转阴率,改善妊娠结局,值得临床推广与应用。     

Squamous cell carcinoma of the uterine cervix in association with stage 0 chronic lymphocytic leukemia/small lymphocytic lymphoma

BACKGROUND: There have been many cases of multiple malignant neoplasms involving the female genital tract reported, but involvement by epithelial and hematologic malignancy is extremely rare. CASE: A 52-year-old woman, who was followed for stage 0 chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), had developed invasive squamous cell carcinoma of the uterine cervix. Microscopic examination of the hysterectomy specimen disclosed invasive squamous cell carcinoma in the cervix and monotonous populations of small lymphoid cells with proliferation centers, which are consistent with CLL/SLL, in the cervix as well as parametrium. Thirty months after the initial diagnosis of CLL/SLL, the patient died with systemic dissemination of squamous cell carcinoma, but the CLL/SLL remained a local disease. CONCLUSION: The clinical course of squamous cell carcinoma in this case appeared to be aggressive, but it was unclear whether the outcome was associated with an altered immune status due to the presence of concurrent CLL/SLL.     

妊娠合并宫颈疾病诊治进展

妊娠期宫颈可发生炎性疾病,人乳头瘤病毒(HPV)感染,宫颈上皮内瘤样病变(CIN)甚至宫颈浸润癌。近年来,对妊娠期宫颈疾病的关注度逐渐上升。妊娠合并宫颈疾病可通过细胞学检查、HPV-DNA检测、P16/Ki67双联染色、阴道镜、活检和宫颈锥切等进行诊断。治疗方面妊娠合并HPV感染没有特别治疗;CIN患者排除宫颈浸润癌后可行细胞学及阴道镜随访至分娩;妊娠合并宫颈癌的处理较为复杂,需要考虑到肿瘤治疗与胎儿安全之间的平衡,治疗需综合考虑肿瘤大小、淋巴结转移情况及患者继续妊娠的意愿。分娩时机及分娩方式方面,合并宫颈感染性疾病及CIN的妊娠患者均按照产科处理;Ⅰa1期、间质浸润深度3 mm并且切缘阴性宫颈癌患者可妊娠至足月阴道试产,对于更高期别患者建议胎儿成熟后剖宫产终止妊娠。