THE CERVIX MULTI－VIRUSES INFECTION AND THE DEVELOPMENT OF CERVICAL CARCINOMAS

ＴＨＥＣＥＲＶＩＸＭＵＬＴＩ－ＶＩＲＵＳＥＳＩＮＦＥＣＴＩＯＮＡＮＤＴＨＥＤＥＶＥＬＯＰＭＥＮＴＯＦＣＥＲＶＩＣＡＬＣＡＲＣＩＮＯＭＡＳＺｈａｎｇＷｅｉ张伟；ＪｉｎＳｎｕｎｑｉａｎ金顺钱；ＬｉｕＢｏｑｉ刘伯齐；ＬｉａｎｓＸｉａｏ梁肖；ＭｉｎｇＬｉｈｕ...     

512例子宫颈癌放射治疗疗效报告

目的 报道512例宫颈癌的治疗结果,寻找提高疗效的途径。方法 对512例子宫颈癌的5年生存率和影响预后的因素进行回顾性分析。结果 放疗后5年生存率分别为Ⅰ期2/2;Ⅱ期74.5％;Ⅲ期56.5％;Ⅳ期28.6％;总的5年生存率为65.4％,与传统腔内治疗的疗效65.7％基本相同,Ⅱ期宫颈病变>4 cm其5年生存率为63.9％;宫颈病变≤4 cm其5年生存率为79.3％(P<0.05),统计学有显著性差异。放疗后放射性直肠炎23例,占4.5％;放射性膀胱炎18例占3.5％。结论 子宫颈癌放射治疗的生存率稳定于65％的水平,改进大宫颈型和分化不好的肿瘤治疗,可能有助提高生存率。     

液基细胞学筛查宫颈癌的研究

目的 评价ThinPrep液基细胞学在宫颈癌高发区筛查的准确性。方法 1997年例受检者同时做宫颈脱落细胞液基标本采集和阴道镜活检,用液基标本做薄片细胞学诊断和肿瘤相关人乳头瘤病毒（human papilloma virus,HPV)检测。细胞学诊断采用TBS分级系统,阳性诊断包括意义不明的不典型鳞状细胞（ASCUS）以上病变,诊断结果与阴道活检诊断和肿瘤相关HPV DNA阳性检出率对照。所有检查均双盲进行。结果 ThinPrep液基细胞学检出100％（12／12）的鳞状细胞癌（SCC）;93．2％（69／74）的鳞状上皮内高度病变（HSIL）,其中CIN396．8％（30／31）,CIN90．7％（39／43）;72．4％（92／127）的鳞状上皮内低度病变（LSIL）。SCC和CIN3的分级准确率分别达100％和87．1％。HPVDNA阳性检出率与细胞学分级密切相关,且在细胞学与组织学相同级别基本一致。结论 宫颈液基标本收集方法有利于细胞学和肿瘤相关HPV DNA双重检查。ThinPrep液基细胞学检查敏感性高,尤其是对鳞状上皮内高度病变。     

外阴前庭大腺腺样囊腺癌患者存活20年一例

1989年4月,患者50岁,因外阴左侧结节增大伴疼痛5～6年于外院行局部肿物切除术后24 d、肿瘤未控首次收入本院,初次手术后病理诊断为左侧前庭大腺腺样囊腺癌、分化程度较差.入院后即行左侧外阴肿物扩大切除+双腹股沟淋巴结活检术;术后病理检查证实为腺样囊腺癌(图1),切缘净,淋巴结阴性.     

高危型人乳头状瘤病毒第二代杂交捕获试验筛查宫颈癌及其癌前病变的验证研究

[目的]验证高危型人乳头状瘤病毒第二代杂交捕获试验(hybridcaptureⅡ,HC-Ⅱ)作为初筛方法检出宫颈病变(≥CINⅡ)的灵敏度和特异度,从而评价HC-Ⅱ检测的临床有效性。[方法]分别以自然人群(山西省襄垣县、沁县)和医院门诊(中日友好医院、北京大学第三医院)妇女为筛查对象的横断面研究,以病理诊断为金标准,开展HC-Ⅱ检测方法的临床验证。筛查对象接受检查时,依次留取Autocyteprep液基细胞学(LCT)和HC-Ⅱ检测标本,并对以上任一项异常者召回行阴道镜下检查和/或活检。[结果]1285例中高危型HPV感染339例,占26.4%;阴性946例,占73.6%。其中在1059例自然人群中高危型HPV感染163例,占15.4%;阴性896例,占84.6%;而在226例医院门诊病例中高危型HPV感染176例,占77.9%;阴性50例,占22.1%。最终参加HC-Ⅱ验证统计分析的共1273例,其中病理诊断≥CINⅡ的160例,HPV阳性同时病理诊断≥CINⅡ的157例。HC-Ⅱ检测样本的灵敏度和特异度分别为98.1%(157/160)和84.5%(941/1113)。阴性预测值和阳性预测值分别为99.7...     

215例老年宫颈癌的临床分析

目的 探讨老年官颈癌的临床特点、治疗效果以及影响预后的因素.方法 回顾性分析215例年龄≥65岁的老年宫颈癌患者的临床资料.215例患者中,192例为Ⅱ b～Ⅳ期的中晚期患者,占89.3%;8例(3.7%)行手术治疗,其中6例术后辅以体外放疗;207例(96.3%)采用放射治疗,其中74例采用同步放化疗.结果 全组患者总的5年生存率为63.7%,Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的5年生存率分别为83.2%、76.4%、39.0%和0.同步放化疗者与单纯放疗者的5年生存率分别为54.1%和59.6%,差异无统计学意义(P=0.4880).多因素分析表明,临床分期、组织学分级、病理类型以及有无淋巴结转移是影响老年宫颈癌患者预后的独立因素(均P<0.05).结论 对于老年宫颈癌患者,治疗宜个体化,应根据患者的具体情况选择合适的治疗方式,尽量选取一种根治手段,不建议综合治疗.     

根治性子宫切除术中保留盆腔自主神经的初步研究

目的 探讨保留盆腔自主神经的根治性子宫切除术(NSRH)的技术要点及可行性,评价其改善子宫颈癌患者术后膀胱功能的作用.方法 选择42例拟行根治性子官切除加盆腔淋巴结清扫术的Ⅰ b1～Ⅰ b2期子宫颈鳞癌患者,研究组(21例)行NSRH,对照组(21例)行常规根治性子宫切除术,比较两组手术时间、失血量及术后留置尿管的时间.采用免疫组化SP法,检测两组患者手术切除的宫骶韧带和主韧带切缘中S-100蛋白的表达,比较两组神经含量的差异.结果 研究组和对照组患者的手术时间分别为(248±24)min和(227±27)min,差异有统计学意义(P<0.01).研究组和对照组患者的术中失血量分别为(459±143)ml和(454±121)ml,差异无统计学意义(P>0.05).研究组和对照组患者术后尿管留置的中位时间分别为7 d和16 d,差异有统计学意义(P<0.01).术后7 d,研究组和对照组残余尿量≤100 ml的患者所占的比例分别为66.7%和19.0%,差异有统计学意义(P<0.01).两组患者均未发生严重的并发症,术后中位随访14个月(11～16个月),无一例患者出现复发转移.S-100免疫组化检测结果 显示,常规根治性子宫切除的切缘中含有大量神经束,而NSRH切缘中仅含有较少的神经纤维,两组相比,差异有统计学意义(P<0.01).结论 NSRH治疗早期子宫颈癌是可行和安全的,能减少手术过程中对盆腔自主神经的损伤程度,降低患者术后尿潴留的发生率.     

宫颈癌多种筛查方案的研究

Objective To assess the feasibility and accuracy of different cervical cancer screening algorithms suitable for different regions, and promote the prevention and control of cervical cancer in China. Methods Using the data of a cross-sectional comparative trial of multiple techniques to detect cervical intraepithelial neoplasia in Xiangyuan County, Shanxi Province, conducted in 1999, to evaluate the feasibility and accuracy of different cervical cancer screening algorithms. All the women were screened by six screening tests, including liquid based cytology ( LBC) , fluorescence spectroscopy, visual inspection with 5% acetic acid staining (VIA) , colposcopy, self-sampled HPV DNA and clinician-sampled HPV DNA test, and each woman had histopathological diagnosis. Different screening algorithms were developed by combining the screening tests in parallel or in serial, and the performance indexes of the algorithms such as sensitivity, specificity, colposcopy referral rate and receiver operating characteristic ( ROC ) curve for detecting the high grade lesions ( ≥CIN 2) were compared. Results Among the algorithms combined by LBC and HPV DNA testing, for the combination in parallel (either cytology was greater than ASC-US or HPV positives) , its sensitivity was 100% , specificity was 68.6% , and colposcopy referral rate was 34.4% ; for the algorithm of LBC as primary screening test, with ASC-US women triage by HPV DNA testing, its sensitivity was 93.0% , specificity was 89.9% , and colposcopy referral rate was 13. 7% ;for the algorithm of HPV DNA testing as the primary screening test, with HPV positive women triage by LBC, its sensitivity was 91. 7% , specificity was 93. 0% , and colposcopy referral rate was 10. 6%. ROC analysis showed that LBC primary testing followed by HPV triage and HPV primary testing followed by LBC triage were much better than the combination in parallel (P =0.0003, P= 0.0002). Among the algorithms with LBC or HPV DNA testing solely as primary screening test, the sensitivity, specificity and colposcopy referral rate of LBC were 94.2% , 77.3% , 25. 7% and 87. 2% , 93. 5% , 10. 0% , respectively, for cutoff by ASC-US or by LSIL; the sensitivity, specificity and colposcopy referral rate of HPV DNA testing were 97.6% , 84. 8% , 18.8% and 83.5% , 85. 9% , 17. 1% , respectively, for clinician-sampled and self-sampled. Clinician-sampled HPV DNA testing was better than LBC cutoff by ASC-US or self-sampled HPV DNA testing ( P = 0. 005, P = 0.002). Among the algorithms combined by VIA and HPV DNA testing, the sensitivity, specificity and colposcopy referral rate were 70. 9% , 74. 3% and 27. 6% for VIA alone as primary screening test; the sensitivity, specificity and colposcopy referral rate were 65. 9% , 95. 2% and 7. 4% for HPV as primary screening test with HPV positive women triage by VIA. HPV primary testing followed by VIA triage was better than VIA alone (P =0. 004). Conclusion Considering the health-resource settings and women's preference, both HPV primary testing followed by LBC triage and LBC primary testing followed by HPV triage are suitable for developed regions, moderately developed regions may choose either LBC or HPV as the screening approach, VIA is a suitable primary screening test in less developed regions, and HPV primary testing followed by VIA triage will be more effective if low cost HPV test is available in the future.     

卵巢转移瘤109例临床分析

:[目的]了解卵巢转移瘤的临床特征 ,探讨其治疗和预后。[方法]对1985年～1996年109例卵巢转移瘤病人进行回顾性分析。[结果]109例卵巢转移瘤占同期收治的卵巢恶性肿瘤的9 7% ,双侧卵巢转移占62 4% ,单侧卵巢转移占37 6% ,伴腹腔转移占71 6%。1年生存率5 0% ,平均生存时间13个月。来源于乳腺癌、淋巴瘤和生殖道癌的卵巢转移瘤平均生存时间为27个月、32个月和22个月 ,来源于结肠癌、胃癌和肺癌的平均生存时间为9个月、8个月和3个月。肿瘤局限在盆腔内的平均生存时间比腹盆腔广泛转移的明显延长(21个月比9个月) ,有显著的统计学意义(P<0 01)。胃肠道和生殖道癌卵巢转移术后残存肿瘤的直径<2cm(理想肿瘤细胞减灭术)的平均生存时间明显长于>2cm者 ,亦有显著的统计学意义(P<0 01)。[结论]卵巢转移瘤常合并腹盆腔广泛转移 ,预后差 ,但手术达理想减瘤者可以明显延长生存     

318例宫颈上皮内瘤变的临床分析

目的探讨宫颈上皮内瘤变(CIN)的临床特点及诊治动向。方法对1999年1月~2003年12月住院治疗318例CIN的临床资料进行回顾分析。结果近5年收治的CIN病例按年平均数计算(63.6例)为前15年(10例)的6.4倍。平均年龄提前6岁,宫颈原位癌提前8.3岁。阴道镜下多点活检与锥切和子宫切除术后病理对照,诊断完全一致208例(65.4%),降级47例(14.8%),阴性11例(3.5%),升级52例(16.4%),包括CINⅠ、Ⅱ级升至CINⅢ级30例(32.6%);CINⅢ级升至早期浸润癌20例(8.8%)及浸润癌2例(0.9%)。CINⅢ级中宫颈原位癌治疗方式在3个阶段(1958~1983,1984~1998,1999~2003年)有明显变化,冷刀锥切的比例从3.0%增到42.2%,子宫切除从77.3%减至52.2%,子宫次广泛切除从27.6%降至4.4%,腔内放疗从28.5%减到零。结论近年CIN病例有上升现象,且有年轻化趋势。细胞学 阴道镜下多点活检 颈管刮术 病理不失为CIN的联合早诊方法。在CIN治疗中宫颈冷刀锥切具有重要价值。