宫颈环形电切术与冷刀锥切术治疗CINⅡ、Ⅲ级疗效分析

目的 评价宫颈环行电切术(LEEP)和宫颈冷刀锥切术(CKC)治疗宫颈上皮内瘤变Ⅱ、Ⅲ级(CINⅡ、Ⅲ)的临床疗效.方法 回顾性分析我院2014年1月至2015年6月收治的124例经阴道镜活检病理确诊为CINⅡ、Ⅲ级患者的临床资料,比较LEEP术(LEEP组,50例)和CKC术(CKC组,74例)治疗CINⅡ、Ⅲ级的临床疗效及术后不良反应发生率.结果 LEEP组术中出血量、手术时间均少于CKC组,差异有统计学意义(P＜0.05);LEEP组术后并发症发生率明显低于CKC组,差异有统计学意义(P ＜0.05);LEEP组术后锥切组织切缘阳性率大于CKC组,差异有统计学意义(P＜0.05);2组术后病理累腺率比较差异无统计学意义(P＞0.05);锥切组织大小比较,CKC组锥切面积、锥高均大于LEEP组,差异有统计学意义(P＜0.05).术后疗效比较,LEEP组与CKC组术后病灶残留率及治愈率比较差异均无统计学意义(P均＞0.05);CKC组复发率明显小于LEEP组,差异有统计学意义(P＜0.05);LEEP组术后高危型HPV感染率高于CKC组,差异有统计学意义(P＜0.05).结论 LEEP出血少、手术时间短以及术后并发症少的优势较易被患者接受,但CKC在锥切组织大小可控性、降低切缘阳性率、减少术后复发及高危型HPV感染率等方面优于LEEP.     

宫颈冷刀锥切术与宫颈电环锥切术治疗宫颈上皮内瘤变的远期随访观察

目的 探讨宫颈冷刀锥切术(CKC)与宫颈电环锥切术(LEEP)治疗宫颈上皮内瘤样病变(CIN)的疗效.方法 180例经阴道镜下多点病理活检确诊为CINⅢ级的患者根据手术方式分为2组,90例患者行CKC治疗作为CKC组,其余90例行LLEP治疗作为LEEP组,记录2组手术情况,随访2 a,记录2组复发率、切缘阳性率、妊娠率.结果 LEEP组手术时间、切口愈合时间及住院时间均较对照组短,术中出血量较对照组少,差异均有统计学意义(P均<0.05);2组术后痊愈率和并发症发生率比较差异均无统计学意义(P均>0.05);2组患者术后2 a切缘阳性率、复发率及妊娠率比较差异均无统计学意义(P均>0.05).结论 CKC与LEEP治疗CIN的手术效果及远期疗效相近,但与CKC相比,LEEP手术时间短,术后恢复快.     

保留生育功能的宫颈冷刀锥切术对早期宫颈癌患者预后的影响

目的 探讨保留生育功能的宫颈冷刀锥切术对早期宫颈癌患者预后的影响。方法 依据手术方法的不同将120例早期宫颈癌患者分为对照组和观察组,每组60例,对照组患者给予阴式广泛宫颈切除术,观察组患者给予宫颈冷刀锥切术。比较两组患者的手术相关指标、血清学指标[C反应蛋白（CRP）、癌胚抗原（CEA）、甲胎蛋白（AFP）]、妊娠结局、并发症发生情况和复发情况。结果 观察组患者手术时间和宫旁切除长度均明显短于对照组,术中出血量明显少于对照组,差异均有统计学意义（P﹤0.01）。手术后,两组患者CEA、AFP、CRP水平均低于本组手术前,观察组患者CRP水平低于对照组,差异均有统计学意义（P﹤0.05）;手术后,两组患者CEA、AFP水平比较,差异均无统计学意义（P﹥0.05）。两组患者异位妊娠率比较,差异无统计学意义（P﹥0.05）。观察组患者的1次、2次成功妊娠率均高于对照组,流产和早产率均低于对照组,差异均有统计学意义（P﹤0.05）。随访17个月,观察组患者的并发症总发生率为6.67%,低于对照组患者的20.00%(P﹤0.05),观察组患者的复发率为3.33%,低于对照组患者的15.00%,...     

经尿道膀胱肿瘤等离子整块剜除术在膀胱癌治疗中的应用效果

目的 比较经尿道膀胱肿瘤等离子整块剜除术(TeURBT)和传统经尿道膀胱肿瘤电切术(TURBT)在膀胱癌治疗中的应用效果.方法 根据手术方法的不同将76例膀胱癌患者分为TeURBT组(n=36,接受TeURBT治疗)和TURBT组(n=40,接受TURBT治疗).比较两组患者的围手术期指标、磷酸化蛋白激酶B(p-AKT)和磷酸化糖原合成酶激酶3β(p-GSK3β)表达情况、国际前列腺症状评分(IPSS)和最大尿流率(Qmax)以及并发症发生情况.结果 TeURBT组患者的手术时间明显短于TURBT组,术中出血量明显少于TURBT组,差异均有统计学意义(P﹤0.01);两组患者的淋巴结清扫数目比较,差异无统计学意义(P﹥0.05).术前和术后6个月,两组患者的p-AKT、p-GSK3β阳性表达率比较,差异均无统计学意义(P﹥0.05);术后6个月,两组患者的p-AKT、p-GSK3β阳性表达率均低于本组术前,差异均有统计学意义(P﹤0.05).术后1个月和术后6个月,两组患者的IPSS和Qmax比较,差异均无统计学意义(P﹥0.05).两组患者的并发症总发生率比较,差异无统计学意义(P﹥0.05).结论 TeURBT治疗膀胱癌的术中出血量少,手术时间短,且治疗效果较好,具有一定的临床应用价值.     

腹腔镜宫颈癌根治术治疗早期宫颈癌的安全性和有效性分析

目的 探讨腹腔镜宫颈癌根治术与开腹宫颈癌根治术治疗早期宫颈癌的临床疗效.方法 回顾性分析104例早期宫颈癌患者的临床资料,根据治疗方式的不同将患者分为观察组(n=52)和对照组(n=52),观察组患者行腹腔镜下宫颈癌根治术,对照组患者行开腹宫颈癌根治术.比较两组患者的术中出血量、手术时间、术后住院时间及并发症发生率;随访8~60个月,比较两组患者的局部复发率和累积生存率.结果 观察组患者的术中出血量明显少于对照组,手术时间和术后住院时间均明显短于对照组,差异均有统计学意义(P﹤0.01).两组患者输尿管损伤、膀胱损伤、肠道损伤、血管损伤、尿潴留、伤口愈合不良、盆腔感染并发症发生率比较,差异均无统计学意义(P﹥0.05).两组患者的局部复发率和5年累积生存率比较,差异均无统计学意义(P﹥0.05).结论 采用腹腔镜宫颈癌根治术可缩短早期宫颈癌患者的手术时间和术后住院时间,减少术中出血量,减轻机体创伤,且不增加局部复发率,未降低远期生存率,是一种安全有效的治疗方式.     

系统回顾:宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变及宫颈原位腺癌的对

由于宫颈癌筛查方案的普及,越来越多的宫颈癌前病变及早期宫颈癌得以及时发现及治疗。宫颈环形电切术（loop electrosurgical excisional procedure,LEEP）及冷刀锥切术（cold knife conization,CKC）作为保守手术方案的代表被广泛使用。本文对LEEP与CKC治疗宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）及宫颈原位腺癌（cervical adenocarcinoma in situ,ACIS）的安全性及有效性进行多方面对比,得出以下结果:对于CIN,LEEP虽然较CKC有着更高的术后复发率,但是在手术时间、术中及术后出血量、住院时间、术后感染率、宫颈管狭窄以及阴道镜检查不满意比例等方面有着明显的优势;对于ACIS,LEEP的切缘阳性率显著高于CKC,二者残留病率及复发率无明显差异;考虑到长期并发症,LEEP较CKC有着早产风险低的优势。总之,根据参考文献,LEEP与CKC均为治疗CIN以及ACIS的安全且有效的手段。对于年轻有生育要求患者,LEEP可能是更好的选择,但需术后严密随访。     

腹腔镜手术与开腹手术治疗宫颈癌的疗效及对患者负性情绪、生活质量的影响

目的 比较腹腔镜手术与开腹手术治疗宫颈癌的疗效及对患者负性情绪、生活质量的影响.方法 依据手术方式的不同将100例宫颈癌患者分为观察组(n=61,接受腹腔镜宫颈癌根治术治疗)和对照组(n=39,接受传统开腹手术治疗).比较两组一般手术指标、负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、生活质量[癌症治疗功能评价系统宫颈癌特异模块(FACT-CX)]和预后情况(生存率、复发率).结果 观察组患者手术时间明显长于对照组(P﹤0.01),术中出血量明显少于对照组(P﹤0.01),术后排气时间和术后住院时间均明显短于对照组(P﹤0.01),淋巴结清扫数明显多于对照组(P﹤0.01).手术后,两组患者SAS、SDS评分均明显低于本组手术前(P﹤0.01),且观察组患者SAS、SDS评分均明显低于对照组患者(P﹤0.01).手术后,观察组患者FACT-CX评分高于本组手术前(P﹤0.05),对照组患者FACT-CX评分低于本组手术前(P﹤0.05),且观察组患者FACT-CX评分高于对照组(P﹤0.05).随访第1、2、3年,两组患者生存率和复发率均无明显差异(P﹥0.05).结论 与传统开腹手术相比,腹腔镜宫颈癌根治术可减少术中出血量,缩短术后排气时间及术后住院时间,增加淋巴结清扫数目,明显改善患者的负性情绪,提高生活质量.     

LEEP和CKC两种手术方式治疗宫颈原位腺癌的效果分析

目的比较宫颈环形电切术(LEEP)与宫颈冷刀锥切术(CKC)治疗宫颈原位腺癌的临床疗效。方法选取2013年6月至2017年6月在海南西部中心医院治疗的宫颈原位腺癌患者75例,平均年龄(35.8±6.5)岁,其中45例采用LEEP治疗(LEEP组),30例采用CKC治疗(CKC组)。观察术中及术后随访情况,比较两组的术中出血量、手术费用、切缘阳性率、残留病灶率及复发率。结果 LEEP组的术中出血量低于CKC组[(15.6±2.3)ml vs.(46.1±22.7)ml],手术费用也低于CKC组[(0.8±0.5)万元vs.(1.5±0.9)万元],差异有统计学意义(P0.001)。LEEP组的切缘阳性率(17.8%vs. 43.3%)、手术残留病灶率(2.2%vs. 16.7%)和复发率(6.7%vs. 23.3%)均低于CKC组,差异有统计学意义(P0.05)。结论 LEEP治疗宫颈原位腺癌具有出血量少、切缘阳性率、残留病灶率和复发率低、手术费用少等优点,值得临床推广应用。     

不同术式治疗宫颈鳞状上皮病变临床病理研究

目的 宫颈癌筛查的普及极大地提高了宫颈癌前病变的检出率,而病理诊断对宫颈癌前病变的诊疗至关重要,癌前病变的精确病理分级对于宫颈癌前病变治疗效果的评价和治疗方法的选择具有重要意义.本研究旨在探讨宫颈鳞状上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ和Ⅲ级病变采用环形电切除术(loop electrosurgical excision procedure,LEEP)和宫颈冷刀锥切术(cold knife conization,CKC)前后,病理分级变化及其对CIN的诊断治疗作用.方法 选择2015-01-01-2015-12 31在靖江市中医院就诊的经阴道镜多点活检病理确诊的CINⅡ和CINⅢ患者149例,随机数字表法分为LEEP组75例和CKC组74例,观察手术前后病理检查的符合度和病理降级、升级率.结果 阴道镜多点活检与LEEP术后CIN病理符合率为56.00％(42/75),LEEP术后病理降级率为21.33％(16/75),病理升级率为22.67％(17/75).阴道多点活检与CKC后CIN病理符合率为66.22％(49/74),病理升级率为12.16％(9/74),病理降级率为21.62％(16/74).宫颈冷刀锥切术和LEEP术后病理与术前病理符合率、病理升级率、病理降级率比较差异均无统计学意义,P＞ 0.05;复发率差异无统计学意义,P＞0.05.结论 CINⅡ和CINⅢ级病变LEEP术和CKC术后病理结果无差异,具有相同的治愈率.建议根据临床及患者意愿选择治疗方法.     

单孔腹腔镜广泛子宫切除术联合盆腔淋巴结清扫术在宫颈癌患者中的应用效果

目的 探讨单孔腹腔镜广泛子宫切除术+盆腔淋巴结清扫术在宫颈癌患者中的应用效果.方法 依据手术方式将120例宫颈癌患者分为单孔组和传统组,每组60例,传统组患者给予传统腹腔镜广泛子宫切除术+盆腔淋巴结清扫术治疗,单孔组患者给予单孔腹腔镜广泛子宫切除术+盆腔淋巴结清扫术治疗.比较两组患者围手术期指标、应激指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)]、生活质量[癌症治疗功能评价系统量表共性模块(FACT-G)]和并发症发生情况.结果 单孔组患者手术时间明显长于传统组(P﹤0.01),术中出血量明显低于传统组(P﹤0.01),首次通气时间、首次排便时间、首次下床活动时间和住院时间均明显短于传统组(P﹤0.01).术后1天,两组患者血清CRP、IL-6水平均高于本组术前(P﹤0.05),且单孔组患者血清CRP、IL-6水平均低于传统组(P﹤0.05).单孔组患者术后并发症总发生率为8.33％,与传统组患者的15.00％比较,差异无统计学意义(P﹥0.05).术后6、12、24个月,两组患者FACT-G评分均逐渐升高(P﹤0.05).结论 与传统腹腔镜手术相比,单孔腹腔镜广泛子宫切除术+盆腔淋巴结清扫术尽管延长了手术时间,但术中出血量更少,应激反应轻微,有利于患者的术后恢复.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.     

Quality of life and care in leukemia, myeloma and non-malignant disease. Opinions of patients and relatives, and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P less than 0.05). Similarly, relatives of decreased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P less than 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P less than 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P less than 0.001). The opinions of patients were similar to those of their relatives. However, the relatives of leukemia patients were even more satisfied with the contact with the medical staff than the patients themselves (P less than 0.05). As many as 10-30% of the relatives never gave up hope for their relative's survival. Only two out of 27 deaths were considered not dignified. The lung carcinoma patients reported a less good quality of life (P less than 0.001), and less satisfaction with the information given (P less than 0.01), than the hematological patients from the same year. Similarly, their attitude to the medical care improved less (P less than 0.01), and they were less content with the general care than the leukemia group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)