150例LEEP刀手术围术期的护理体会

目的：探讨Leep刀手术治疗宫颈上皮内瘤变患者围术期护理方法。方法：自2007年3月-2010年10月,对150例宫颈上皮内瘤变患者行Leep刀手术,术前给予心理护理与术前准备、术中及术后各期均给予精心护理,做好并发症的预防与处理。结果：本组患者手术顺利进行,无一例发生并发症,一次性治愈率达96%。结论：将人文关怀融入Leep刀手术的护理工作,可使患者在接受手术时充满信心,为手术的顺利进行创造良好的条件,提高手术成功率,预防并发症发生。     

LEEP刀治疗宫颈上皮内瘤变73例临床观察

宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)临床上多见,且易发展为宫颈癌,近年来已经引起了广泛关注。LEEP刀属于一种微创手术,具有对周围组织创伤小、术中并发症少、术后恢复好等优点,在宫颈疾病,特别是宫颈糜烂及CIN的诊断与治疗中应用非常广泛。本文回顾性分析我省某院应用LEEP刀治疗的90例CIN患者的临床资料,评价其临床疗效,现将结果报道如下。     

LEEP治疗中老年妇女宫颈上皮内低度瘤样病变36例临床分析

目的:探讨LEEP治疗中老年妇女宫颈上皮内低度瘤样病变(CIN Ⅰ)的临床价值.方法:收集2004年1月至2006年11月来我院子宫颈疾病诊治中心就诊,阴道镜下活检,病理确诊为CIN Ⅰ,自愿行LEEP术治疗的153例病例,将其按年龄段分为中老年组(36例)和青年组(117例)进行临床分析,对比研究阴道镜下多点活检和LEEP术后的病理检查结果.结果:宫颈LEEP术后病理降级为慢性宫颈炎,宫颈湿疣样变的共有56例(占36.60%,其中25%HPV阳性),其中,中老年组为6例,HPV阳性1例;青年组为50例,HPV阳性13例.宫颈LEEP术后病理保持为CIN Ⅰ的有78例(占50.98%,其中53.85%HPV阳性),其中中老年组为21例,HPV阳性11例;青年组为57例,HPV阳性31例.宫颈LEEP术后病理升级的有19例(占12.42%),其中CINⅡ有12例(中老年组为5例,青年组为7例),占7.84%,CIN Ⅲ级以上有7例(中老年组为4例,青年组为3例),占4.58%,其中包括1例原位癌,1例镜下早期浸润癌均在中老年组中.病理升级病例中HPV阳性率为100%.结论:对HPV阳性的中老年妇女CIN Ⅰ患者实施LEEP治疗有重要的临床价值,可以早期发现更高级别的宫颈病变甚至宫颈癌.     

高频电波刀治疗宫颈上皮内瘤变

宫颈上皮内瘤变（CIN）是宫颈癌前病变．发展为原位癌和浸润癌的风险是正常的20倍和7倍，CINⅠ、CINⅡ和CINⅢ发展到癌的危险分别是15％、30％、45％，CINⅠ或CINⅡ甚至可以不经过CINⅢ阶段直接发展为浸润癌。因此早期诊断和治疗CIN是防癌和治癌的关键。我院使用高频电波刀治疗CIN53例，总结报道如下。     

LEEP刀治疗119例宫颈糜烂的疗效观察

目的 观察LEEP刀治疗宫颈糜烂的疗效.方法 应用LEEP刀治疗119例确诊的官颈糜烂,并观察其治愈率.结果 LEEP刀治疗宫颈糜烂、轻度糜烂治愈率达到100.0%,中度95.8%,重度84.4%,总治愈率达到93.2%.结论 LEEP刀治疗宫颈糜烂疗效确切,可作为治疗慢性宫颈炎症的有效治疗措施.     

LEEP 刀联合保妇康栓治疗高危型 HPV 感染 CIN 的临床观察

目的：探讨高危型HPV感染CIN患者的治疗方法,为高危型HPV感染CIN患者的早期治疗寻求新途径.方法：对2006年3月至2010年6月在我院诊断的高危型HPV感染的CIN患者140例进行随机分组后治疗,分为LEEP联合保妇康栓组、LEEP组,治疗后随访2年,复查监测指标,观察每组的治疗效果.结果：LEEP组治疗后6个月、12个月、18个月及24个月的高危型HPV清除率分 别为80.0%、82.9%、84.3%、92.9%,LEEP联合保妇康栓组的分别为82.9%、94.3%、95.7%、98.6%,2组相比有显著性差异.治疗后2年的宫颈活检结果显示LEEP联合保妇康栓组的CIN率低于LEEP组.结论：LEEP联合保妇康栓治疗可提高高危型HPV感染CIN患者的HPV清除率,降低CIN复发率,优于其他单一治疗方法.     

高频电波刀治疗宫颈上皮内瘤变

宫颈上皮内瘤变(CIN)是宫颈癌前病变,发展为原位癌和浸润癌的风险是正常的20倍和7倍,CIN I、CIN II和CIN III发展到癌的危险分别是15%、30%、45%,CIN I或CIN II甚至可以不经过CIN III阶段直接发展为浸润癌[1]。因此早期诊断和治疗CIN是防癌和治癌的关键。我院使用高频电波刀治疗CIN 53例,总结报道如下。1资料与方法1.1一般资料自2000年6月—2004年10月,我院使用高频电波刀行宫颈环形电切术(LEEP),治疗CIN53例,年龄24~56岁,主要临床表现为阴道分泌物增多和接触性出血。部份患者无症状,体检时发现。未生育者5例,已生育者48…     

高频电波刀治疗宫颈上皮内瘤变的疗效分析

目的探讨高频电波刀治疗官颈上皮内瘤变（CIN）的临床应用及疗效．方法选择电子阴道镜下活检病理诊断为CIN的病人378例,经阴道镜辅助高频电波刀治疗,治疗方法分别采用LEEP锥切术（165例）、活检术（213例）,对其疗效及术后病变的持续存在和复发等情况进行分析．结果LEEP术前术后病理诊断CIN相符合者290例（76．72％）,CIN级别减低118例（31．22％）,CIN级别升高47例（12．43％）．6mo内总的治愈率99．73％（372／373）,CIN病变持续存在率为0．27％（1／373）,复发率0．54％（2／373）．19例（5．09％）出现官颈管狭窄．结论高频电波刀治疗CIN能得到完整的病理标本,治疗的同时有诊断的作用,手术安全、有效、方便,是治疗CIN的理想方法,术后定期随访十分重要．     

LEEP刀治疗宫颈病变88例临床观察

目的探讨LEEP刀在宫颈病变诊断和治疗中的应用。方法对88例宫颈疾病采用LEEP刀手术治疗,术后标本做病理检查。结果 88例宫颈病变均一次手术成功,病理检查符合率94.3%,3例病理级别上升,1例病理级别下降。结论 LEEP刀治疗宫颈病变治愈率高、效果好,且对早期诊断宫颈癌具有重要的临床意义。     

LEEP术在宫颈癌前病变应用中的研究进展

近年来,随着宫颈癌筛查水平的不断提高,其发病率逐年下降,但宫颈癌前病变的检出率逐年上升并呈现出年轻化的趋势。如何有效地诊治宫颈癌前病变,成为广大妇科医师极为关注的话题。对于宫颈细胞学检查异常的患者,其处理方式已由单纯的冷刀锥切、电灼到冷冻等手术直至现在的高频电波刀宫颈环切术(Loop electrosurgical excision procedure,LEEP)。LEEP 治疗宫颈上皮内瘤样病变(Cervical intraepithelial neoplasia,CIN)效果已得到广大学者和临床医师认可,治疗也日臻完美,然而随着对此项技术的深入研究,LEEP术在宫颈癌前病变某些诊治环节中不同观点日渐凸显出来,因此本文将主要针对有争议的术后妊娠结局、复发高危因素等进行综述。     

应用普通电刀的宫颈锥切术诊治宫颈上皮内瘤变和微小浸润癌的临床观察

背景与目的：高频电波刀电圈切除术和宫颈冷刀锥切术已经广泛应用于宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）的诊治中。本研究旨在探讨普通电刀的宫颈锥切术在CIN和微小浸润癌的诊治中的临床应用价值。方法：回顾性分析2004年4月至2006年7月间在我院接受普通电刀的宫颈锥切术的173例患者的临床病理资料。记录手术时间、手术出血量，分析术后病灶残留、手术前后病理符合情况及再次手术情况。结果：173例患者平均年龄37．2岁（23～63岁），绝经3例，未生育者5例。手术中位时间为5min，中位出血量为5ml。锥切标本的病理诊断较阴道镜下活检或宫颈多点活检有降级或升级，各级别病变中手术前后的病理符合率为61．3％（25．0％～72．4％）。在163例术前诊为CIN的患者中，共发现9例微小浸润癌ⅠA1期，3例ⅠA2期。8例术前诊为微小浸润癌ⅠA1期中，3例间质浸润深度超过微小浸润癌范围被诊为局部早期浸润癌ⅠB1期。最后诊为ⅠA1期的14例患者中，1例切缘阳性者再次行锥切术，另有5例行次广泛全子宫切除术。所有ⅠA2期患者和ⅠB1期患者术后接受宫颈癌根治术。最后诊为CIN的151例患者中，3例切缘阳性，其中1例补充行全子宫切除术。2例术前活检阴性者锥切术后被证实为浸润性腺癌，另有3例CIN患者同时合并原位腺癌，术后均予再次手术。结论：应用普通电刀的宫颈锥切术是一种设备简单、手术时间短、出血少，且切净率高的诊治CIN和微小浸润癌的方法。其对宫颈微小浸润癌、局部早期浸润癌和腺癌的诊断率高。锥切术后为早期浸润癌或切缘阳性者，应根据具体情况进一步处理。     

子宫颈抹片检查常规筛查宫颈组织、癌前病变或癌变在发展中国家门诊中的运用(英文)

Objective  

Papanicolou (Pap) smear screening has dramatically reduced the incidence of invasive cervical cancer worldwide. Pap smear screening is still not widely available in developing countries and therefore cannot be used as mass screening tool. This study was designed to establish the role of Pap smear as a routine investigation for females presented to gynecological department.     

宫颈上皮内瘤变相关影响因素病例对照研究

目的 宫颈癌是全球范围内高发于女性的恶性肿瘤,宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)是其癌前病变.本研究旨在探讨CIN的相关影响因素,分析高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)及沙眼衣原体(chlamydia trachomatis,CT)感染与CIN的相关性.方法 选择2010-01-01-2014-04-30柳州市人民医院门诊就诊的女性患者,共纳入符合筛查条件的患者12 644例,行宫颈脱落细胞CT和HR-HPV-PCR检测,以及液基薄层细胞学检查,必要时宫颈活组织检查.记录CT及HR-HPV不同感染状态发生CIN的情况,应用SPSS17.0软件包进行非参数检验和多因素Logistic回归分析.结果 12 644例患者中,检查出CIN 260例,检出率为2.06％.HR-HPV(OR=18.516)、CT感染(OR=2.602)、妊娠次数增加(OR=1.477)和年龄(OR=1.690)与CIN发生相对危险度增加.以HR-HPV和CT不同感染状态进行分层,CIN在不同HR-HPV及CT感染状态组别中发生率不同,HR-HPV和CT均阳性组最高(18.00％),其次依次为HR-HPV阳性组(10.26％)、CT阳性组(1.97％)、HR-HPV和CT均阴性组(0.49％),差异均有统计学意义,x2 =875.927,P＜0.001.结论 年龄与孕次增加是CIN发生的相关影响因素,HR-HPV与CIN发生密切相关,宫颈CT感染亦与CIN发生相关,CT与HR-HPV协同可能增加CIN发生.     

Management of HPV-positive women in cervical screening using results from two consecutive screening rounds

We studied whether triage of human papillomavirus (HPV)-positive women participating in an HPV-based screening programme can be improved by including the HPV result at the previous screen in the triage algorithm. We analyzed data of a subgroup of 366 women from the POBASCAM trial, screened by cytology and HPV cotesting. Women were included if they tested HPV-positive in the second HPV-based screening round. We evaluated the clinical performance of 16 strategies, consisting of cytology, HPV genotyping, and/or previous screen HPV result. The clinical endpoint was cervical precancer or cancer (CIN3+). The current Dutch triage testing policy for HPV-positive women is to refer women for colposcopy if they have abnormal cytology at baseline or after 6–18 months. In the second HPV-based screening round, this strategy yielded a negative predictive value (NPV) of 95.8% (95% confidence interval: 91.9–98.2) and colposcopy referral rate of 37.6% (32.3–43.2%). Replacing repeat cytology by the previous screen HPV result yielded a similar NPV (96.9%, 93.3–98.9) and colposcopy referral rate (38.8%, 33.4–44.4). A higher NPV (99.2%, 96.3–100%) at the cost of a higher colposcopy referral rate (49.2%, 43.6–54.8) was achieved when cytology was combined with HPV16/18 genotyping. The other 13 triage strategies yielded a lower NPV, a higher colposcopy referral rate or performed similarly but required additional testing. HPV-positive women in the second HPV-based screening round can be suitably managed by cytology, HPV16/18 genotyping and the HPV result at the previous screen, obviating the need for repeat testing of HPV-positive, cytology negative women.     

宫颈上皮内瘤变患者血清HPV16病毒颗粒IgG1、IgG2亚类抗体变化及意义(英文)

Objective:The paper aimed to study the relationship between the expressions of immunoglobulin G(IgG) subclasses toward human papillomavirus 16-like particles(HPV16VLPs) in the serum of patients and different grades of cervical lesions.Methods:The expressions of IgG subclasses in 32 cases of human papillomavirus(HPV) infection,30 cervical intraepithelial neoplasia(CIN I),43 CIN Ⅱ-Ⅲ,and 24 hysteromyoma and chronic cervicitis were examined by ELISA.Results:The absorbance values of HPV16VLPs-IgG,IgG1 increased ...     

Mortality in a long‐term follow‐up after treatment of CIN

After treatment of the cervical intraepithelial neoplasia (CIN) cervical cancer incidence remains elevated at least for 20 years. Whether the overall or cervical cancer mortality after treatment of CIN is elevated is unknown. The aim of this study was to determine the long‐term survival and cause‐specific mortality among women treated for CIN. The study population consisted of 7,104 women treated for CIN between 1974 and 2001 and 35,437 individually matched controls. The follow‐up of mortality was based on nationwide registries and closed at death, emigration or December 31, 2005. The possible differences in mortality were assessed using Cox proportional hazard model. With follow‐up time of approximately 630,000 woman‐years, overall 2,781 deaths were observed, 530 among women treated for CIN and 2,251 among reference population (HR 1.1, 95% CI 1.0–1.3). Mortality from any cancer (HR 1.4, 95% CI 1.2–1.7), lung cancer (HR 2.7, 95% CI 1.8–4.1) and HPV‐related anogenital cancer (HR 3.1, 95% CI 1.1–8.6) was higher among CIN patients, but mortality from cervical cancer was not (HR 1.0, 95% CI 0.3–4.0). Elevated cervical cancer incidence after treatment of CIN, documented earlier, did not predict elevation in cervical cancer mortality. This suggests high effectiveness of CIN management. Most of the excess mortality observed among CIN patients was due to increased risk of other cancers. These long‐term mortality patterns should be considered when planning and evaluating the management of CIN lesions and related cervical or other cancer prevention activity.     

Incidence risk of cervical intraepithelial neoplasia 3 or more severe lesions is a function of human papillomavirus genotypes and severity of cytological and histological abnormalities in adult Japanese women

We examined incidence probabilities of cervical intraepithelial neoplasia 3 (CIN3) or more severe lesions (CIN3+) in 1,467 adult Japanese women with abnormal cytology in relation to seven common human papillomavirus (HPV) infections (16/18/31/33/35/52/58) between April 2000 and March 2008. Sixty‐seven patients with multiple HPV infection were excluded from the risk factor analysis. Incidence of CIN3+ in 1,400 patients including 68 with ASCUS, 969 with low grade squamous intraepithelial lesion (LSIL), 132 with HSIL without histology‐proven CIN2 (HSIL/CIN2(?)) and 231 with HSIL with histology‐proven CIN2 (HSIL/CIN2(+)) was investigated. In both high grade squamous intraepithelial lesion (HSIL)/CIN2(?) and HSIL/CIN2(+), HPV16/18/33 was associated with a significantly earlier and higher incidence of CIN3+ than HPV31/35/52/58 (p = 0.049 and p = 0.0060, respectively). This association was also observed in LSIL (p = 0.0002). The 1‐year cumulative incidence rate (CIR) of CIN3+ in HSIL/CIN2(?) and HSIL/CIN2(+) according to HPV genotypes (16/18/33 vs. 31/35/52/58) were 27.1% vs. 7.5% and 46.6% vs. 19.2%, respectively. In contrast, progression of HSIL/CIN2(+) to CIN3+ was infrequent when HPV DNA was undetected: 0% of 1‐year CIR and 8.1% of 5‐year CIR. All cervical cancer occurred in HSIL cases of seven high‐risk HPVs (11/198) but not in cases of other HPV or undetectable/negative‐HPV (0/165) (p = 0.0013). In conclusion, incidence of CIN3+ depends on HPV genotypes, severity of cytological abnormalities and histology of CIN2. HSIL/CIN2(+) associated with HPV16/18/33 may justify early therapeutic intervention, while HSIL/CIN2(?) harboring these HPV genotypes needs close observation to detect incidence of CIN3+. A therapeutic intervention is not indicated for CIN2 without HPV DNA.     

光动力治疗人乳头瘤病毒感染和宫颈上皮内瘤变的临床应用进展

光动力疗法是联合应用光敏剂及其相关光源,利用光动力学反应选择性破坏肿瘤组织的治疗方法.目前光动力疗法作为一种新的疗法已经在HPV感染和CIN的治疗中广泛应用并取得了良好的治疗效果,通过对国内外光动力疗法在治疗HPV感染及CIN的临床应用的综述,可以为进一步深入研究提供理论依据.