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51.
1 前哨淋巴结的概念与检测方法
前哨淋巴结(sentinel lymph node,SLN) 的概念最早于 1977年被提出,当时 Cabanas[1]在阴茎背侧进行淋巴造影时发现一种 " 特殊 " 的淋巴结,该淋巴结最先接受肿瘤部位的淋巴引流,为最早发生肿瘤转移的淋巴结,故将其命名为 SLN. 理论上 SLN最早发生肿瘤转移,故术中对 SLN的检测及评估对恶性肿瘤的外科处理具有指导意义.近年来,术中 SLN的检测于各国先后展开,文献报道 [2]主要的检测方法可归纳为以下 3种 :(1) 术中利用美蓝等生物活性染料使淋巴管淋巴结着色的方法 ;(2) 注射放射性胶体(如 99mTc-DX),淋巴闪烁显像结合γ计数器探测仪检测的方法 ;(3) 联合应用生物活性染料与放射性胶体识别的方法. 相似文献
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子宫恶性中胚叶混合瘤 总被引:3,自引:0,他引:3
37 patients with malignant mesodermal mixed tumor of the uterus treated from 1958 to 1987 were reviewed. It accounted for 38.5% of all uterine sarcomas during the same period. Six were homologous and 31 were heterologous in origin. The mean age was 56.8 years. 75.5% of the patients were postmenopausal. Nine (24.3%) patients had previous pelvic irradiation. There were 13 Stage I, 4 Stage II, 5 Stage III, 2 Stage IV and 13 unstaged (including 11 misdiagnosed and 2 operated in other hospital) lesions as classified according to the FIGO Staging System for malignant tumors of the Endometrium and Cervix. Twenty-six patients were treated by combined surgery and radiotherapy or chemotherapy and radiotherapy, 5 by radiotherapy alone and 6 by surgery alone. The overall 2-year survival rate was 35.1%. Twenty-two (59.5%) patients developed recurrence and/or metastasis and 86.4% (19/22) did so within 2 years after treatment. The most significant prognostic factors were: the depth of myometrial invasion, extent of lesion and method of treatment. The best 2-year survival rate (83.3%) was seen in patients treated by the combined use of surgery, radiotherapy and chemotherapy which is considered the treatment of choice for this malignancy. 相似文献
54.
外阴上皮内瘤变(VIN)较少见,近年发病呈上升趋势.其生物学行为尚不完全清楚,有关基础研究已取得一定进展.由于VIN发病年龄趋于年轻化,临床处理趋于保守,但必须强调长期随访.对VIN的发病情况、临床表现、基础研究、治疗进展及预后等进行综述. 相似文献
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Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively. 相似文献
57.
高危型人乳头瘤病毒载量与子宫颈病变的关系 总被引:2,自引:0,他引:2
目的 研究妇女生殖道感染高危型人乳头瘤病毒(HR-HPV)的载量与各级子宫颈上皮内瘤变(CIN)的关系.方法 汇总1999-2008年间在我国14 6个城市地区和8个农村地区开展的以人群为基础的子宫颈癌筛查横断面研究的数据.共有18 186名17~59岁的妇女参加了筛查,并收集子宫颈脱落细胞用于HR-HPV DNA检测.采用第2代杂交捕获试验(he2),病毒载量由样本的相对光单位与标准阳性对照之比(RLU/PC)来衡量.根据HR-HPV载量,除阴性组[0,1.00)以外,将阳性对象分为3组:低度载量[1.0,10.00),中度载量[10.00,100.00)和高度载量≥100.00.子宫颈病变按照病理诊断分为正常、轻度宫颈上皮内瘤变(CIN 1)、中度宫颈上皮内瘤变(CIN 2)、重度宫颈上皮内瘤变(CIN 3)和子宫颈癌(SCC).采用非条件多项式logistic回归分析病毒载量与子宫颈病变级别的关系.结果 HR-HPV感染率为14.51%(2515/17 334),其中100.00%(29/29)的SCC、97.63%(206/211)的CIN 3、93.43%(199/213)的CIN 2、75.04%(421/561)的CIN 1和10.17%(1660/16 320)的正常妇女HR-HPV DNA检测阳性.HR-HPV感染阳性的SCC、CIN 3、CIN 2、CIN 1和官颈正常妇女的病毒载量中位数分别是320.85、158.05、143.70、125.34和9.64.各级病变中病毒载量的分布差异有统计学意义(X2=6190.40,P<0.01);病毒载虽越高,CIN程度越高(X2=5493.35,P<0.01).低、中和高度载量组与阴性组相比,发生各级CIN的危险性均增加[OR(95%C/):CIN 1为9.01(6.31~12.87)、24.96(18.23~34.17)和68.42(51.40~91.08),CIN 2为26.44(12.07~57.95)、98.53(49.54~195.98)和322.88(168.62-618.27),CIN 3+为72.89(24.02~221.18)、343.58(121.81~969.09)和>999.99(473.38~>999.99)],有明显的剂量反应关系(X趋势2势分别为3115.05、2413.95和3098.57,P值均<0.01).HR-HPV阳性人群各年龄组内,HR-HPV中、高度载量组患CIN 2+的危险性高于低载量组[OR值(95%CI):<35岁组为4.71(1.23~18.09)和15.06(4.40~51.49),35岁~组为4.01(1.62~9.90)和14.09(6.15~32.28),40岁~组为3.06(1.52~6.16)和7.78(4.05~14.95),≥45岁组为3.50(1.36~9.01)和7.57(3.13~18.30)],且随病毒载量升高,危险性升高(X趋势2分别为51.33、66.28、53.64和51.00,P值均<0.01);高载量40岁~组患CIN 2+的风险最大[OR值(95%CI)为2.02(1.15~3.52)].结论 子宫颈HR-HPV病毒载量与子宫颈癌及癌前病变级别、CIN 2+患病率高度相关;中、高度病毒载量是SCC、CIN 2和CIN 3的主要危险因素,其对于35岁以上女性的致病风险更大.综合考虑年龄和病毒载量将有助于医生有效地分类管理患者或筛查妇女. 相似文献
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子宫颈癌筛查方法的横断面比较研究 总被引:153,自引:4,他引:153
目的评价现行的或最新的六种子宫颈癌及癌前病变筛查方法的诊断效果,为制定不同人群子宫颈早期癌及癌前病变的筛查方案及最终降低子宫颈癌的发病率及死亡率提供科学依据。方法以病理组织学为金标准,在山西省襄垣县对1997位35~45岁的妇女同时采用六种针对宫颈癌及癌前病变的筛查方法进行筛查。筛查方法包括:人乳头瘤病毒(HPV)自己取样法、荧光分光镜检法、液基细胞学薄片法、HPV直接检测法、5%醋酸染色后直接肉眼观察及阴道镜检查;同时对被检对象进行宫颈癌危险因素调查。结果该人群宫颈高度鳞状上皮内瘤样变及癌(≥CIN II)的现患率为4.3%(86/1997)。以病理组织学结果为金标准(≥CIN II为阳性),检测各筛查方法的灵敏度及特异度分别为:HPV自己取样(0.835,0.859)、液基细胞学薄片法(≥CIN I为阳性)(0.872,0.935)、HPV直接检测法(0.952,0.859)、5%醋酸染色后直接肉眼观察(≥低度病变为阳性)(0.709,0.743)、阴道镜检查(≥低度病变为阳性)(0.814,0.765);荧光分光镜检查(0.91,0.09);运用约登指数比较各筛查方法的结果:HPV自己取样法与HPV直 相似文献
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目的 分析我市某区脑卒中患者发病及其主要危险因素,为脑卒中患者的预防控制提供参考依据。方法 采用随机整群抽样法,以街道办事处(乡镇)、社区村委会(社区居委会)所辖社区常住人口底册为依据,以居民家庭为单位,以40岁以上常住居民为调查对象进行问卷调查,采用多因素非条件logistic回归分析探讨其脑卒中发病的危险因素。结果 在我市某区29 505名40岁以上常住居民中,脑卒中患者915例,脑卒中患病率为3.10%。不同性别、年龄、吸烟情况、运动情况、脑卒中家族史、高血压史、血脂异常、体质量指数患病率不同,差异均有统计学意义(P<0.01)。男性、年龄≥50岁、吸烟、有脑卒中家族史、高血压史、血脂异常、体质量指数≥18.5 kg/m2的常住居民脑卒中患病率较高,女性和经常运动的脑卒中患病率较低。结论 40岁以上脑卒中患病率较高,性别、年龄、吸烟情况、运动情况、脑卒中家族史、高血压史、血脂异常、体质量指数是该地区常住居民脑卒中患病的主要危险因素。 相似文献
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