宫颈癌放疗后液基薄层细胞学检测分析

目的分析宫颈癌放疗后宫颈细胞学改变特点及该项检测的临床意义。方法196例宫颈癌放疗后患者放疗结束1个月后行489次宫颈液基薄层细胞学检查(LCT)。采用2001年版TBS诊断系统,对细胞改变作描述性诊断。结果在放疗结束1年内,鳞状上皮表层细胞体积增大不明显、核可增大,但较疏松、胞浆丰富,可出现空泡。部分涂片上可见退变的癌细胞,部分病例见修复细胞和化生细胞。异常鳞状上皮细胞检出率为40.3%,其中不典型鳞状细胞(ASCUS)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)分别为20.1%,5.3%、10.8%。鳞癌(SCC)检出率为3.1%。炎症反应性细胞检出率为42.5%,其中轻、中、重度分别为6.3%,19.4%,16.8%。35例放疗后因细胞学检查异常进行了局部病理组织学检查,病理与LCT两者符合率为91%。结论宫颈液基薄层细胞学可作为宫颈癌放疗后局部有无复发及放射反应的监测指标。     

尿激酶受体在宫颈癌组织中的表达

目的：研究宫颈癌患者尿激酶型纤溶酶原激活物受体（uPAR）在癌组织中的变化，初步探讨uPAR与宫颈癌浸润、转移及预后的关系。方法：通过免疫组织化学SABC法检测uPAR在43例宫颈癌组织和10例正常宫颈组织的表达。结果：将组织标本按病理学检查结果分为宫颈癌组和正常宫颈组，免疫组织化学结果提示宫颈癌组uPAR阳性表达率为65．12％，而正常宫颈组uPAR未见阳性表达，两组相比差异有统计学意义（P〈0．01）。宫颈癌患者癌组织uPAR的表达与其临床分期、淋巴结是否转移具有相关性（P〈0．05）。结论：与正常宫颈组相比，宫颈癌患者癌组织uPAR呈异常高表达。uPAR在宫颈癌的生长、侵袭转移过程中可能起着重要的作用。检测其在组织中的表达有助于判断患者的病情及预后。     

经阴道彩色多普勒诊断宫腔疾病

目的:探讨经阴道彩色多普勒(TVCD)诊断宫腔内疾患的临床应用价值。方法:应用TVCD诊断我院2005～2007年因阴道不规则出血、绝经后出血及不孕不育症的患者103例,根据其超声所见分为:子宫内膜癌、粘膜下肌瘤、子宫内膜息肉、内膜良性增生、内膜萎缩、宫内节育器移位。并与宫腔镜检查及临床手术后的病理结果进行对照。结果:超声诊断符合率为:子宫内膜癌77.8%(7/9),粘膜下肌瘤80.0%(8/10),内膜息肉91.0%(20/22),内膜良性增生92.3%(12/13),内膜萎缩100.0%(22/22),宫内节育器下移93.7%(15/16)。结论:TVCD与经腹部超声比较,可清楚显示子宫腔内病变,有助于宫腔内病变的诊断,提高诊断准确率,为临床医生提供可靠的诊断资料,择期手术。     

Clear-cell adenocarcinoma of the uterine cervix in a 17-year-old adolescent

This report describes the case of the youngest Japanese person to be diagnosed with endocervical clearcell adenocarcinoma. In September 2005, a 17-year-old female adolescent visited a physician because of vaginal bleeding. A cervical tumor was discovered, and the patient was referred to our outpatient department. Vaginal examination showed a bleeding tumor approximately 1.5 cm in size protruding from the cervical os. The cytological finding of the uterine cervix was positive for malignancy, and the histological diagnosis by punch biopsy was clear-cell adenocarcinoma of the uterine cervix. A radical abdominal hysterectomy and pelvic lymphadenectomy were performed on October 30. Macroscopic findings showed a tumor, 1.5 cm in diameter, growing from the right side of the uterine cervix. The pathological diagnosis was clear-cell adenocarcinoma of the cervix (PT1b1NR0M0). The patient was discharged from our hospital without any adjuvant therapy. No signs of recurrence have been detected in the 2-year follow up.     

宫颈疾病筛查11 179例结果分析

目的探讨宫颈疾病的发病情况及特点，为宫颈癌的早期预防工作提供依据。方法2004年4月至2006年3月在计生站行宫颈细胞学检查、HPVDNA检测配合阴道镜检查对子宫颈病变进行筛查，以组织学为金标准，对结果进行分析。结果宫颈涂片11179例，异常涂片351例（3．41％）；宫颈HPV DNA检测11179例，阳性156例（1．395％）；阴道镜检查1140例，104例在阴道镜指引下宫颈活体组织检查。病理结果显示：宫颈上皮内瘤样变（CIN）83例（检出率7．9．81％），其中CINⅠ33例，CINⅡ10例，CINⅢ40例，HPV感染8例。HPV DNA检测阳性高峰年龄为30～34岁（31．41％），CIN发病年龄在30～44岁之间的病例占86．75％。宫颈轻度糜烂占发生CIN总数的33．73％，其中CINⅡ、CINⅢ分别占40％和30％，宫颈光滑者占CIN总数的28．92％。宫颈细胞学检查异常、HPV DNA检测阳性，活检确诊为CIN与宫颈细胞学检查异常而HPV DNA检测阴性活检确诊为CIN，经’0检验差异有统计学意义（P〈0．05）。宫颈涂片细胞学检查诊断CAN符合率86．30％；阴道镜检查对CIN的诊断符合率96．39％（80／83），两者比较差异有统计学意义（P〈0．05）。结论采用宫颈细胞学检查、HPVONA检测配合阴道镜下病理检查能及早发现宫颈癌的瘤前病变，30～44岁年龄妇女是宫颈癌防治的重点人群。对HPV阳性者要进行严格的宫颈癌追踪检查。     

经导管动脉化疗栓塞治疗中晚期子宫颈癌疗效观察

目的探讨和评价经导管动脉化疗栓塞治疗中晚期宫颈癌的应用价值。方法对29例中晚期子宫颈癌患者进行双侧髂内动脉前干或子宫动脉化疗及栓塞治疗。按国际妇产科协会临床分期标准：Ⅱb期22例,Ⅲb期7例,均无盆腔外转移。其中鳞癌25例,腺癌3例,鳞腺癌1例。结果全部患者术后阴道出血停止,症状明显改善。25例行根治性手术切除,20例Ⅱb期患者宫旁组织内未见癌细胞。结论经导管动脉化疗栓塞治疗中晚期宫颈癌可减少淋巴结和脉管内的亚临床转移,提高手术切除率,是一种安全有效的新方法。     

子宫颈腺癌136例分析

1956～1989年本院收治子宫颈腺癌136例,平均年龄48.9岁。其中11％无症状,均以手术治疗为主,广泛性全子宫切除术及盆腔淋巴清扫术76例,广泛性全子宫切除术加放疗45例,淋巴转移率为Ⅰ期12.3％,Ⅱ期40.5％。5、10年生存率分别为90.8±2.9％、86.0±4.4％;15、20、25年生存率分别为81.0±4.4％。预后与期别淋巴结转移有关。     

CA 125 in normal tissues and carcinomas of the uterine cervix,endometrium and fallopian tube

Summary The study deals with the occurrence of cancer antigen 125 (CA 125) in the normal and neoplastic uterine cervix, endometrium and fallopian tube and its applicability as a tumour marker. CA 125 concentrations were measured in 52 secretion specimens, in cytosol fractions of 97 tissue biopsies and in serum from 47 women with nonmalignant disorders and from 334 patients with carcinomas. High quantities of CA 125 (780-454860 U/ml) were detected in cervical mucus, intra-uterine and tubal fluid, exceeding those in the corresponding serum samples by factors of up to 2000. CA 125 concentrations were 9–53 fold higher in cytosol fractions of normal and neoplastic glandular epithelia of the endocervix and endometrium than in those of cervical squamous epithelia and the cervical wall. Despite similarly high antigen concentrations in normal glandular epithelia and adenocarcinomas serum levels elevated to above 65 U/ml were only found in patients with malignant tumours. The positivity rates in serum increased with tumour extent and were 0–43% for primary and 63–79% for recurrent cervical, endometrial and tubal adenocarcinomas. During long-term follow-up, CA 125 serum concentrations were concordant with the clinical course in 10 out of 11 patients with progressive carcinomas. According to these results, the release of CA 125 into the peripheral blood is apparently dependent on the infiltrative growth and the mass of the tumour rather than on, the local tissue concentrations. The clinical use of CA 125 is limited to the detection of advanced adenocarcinomas of the Müllerian duct.Presented in part at the 46. Tagung der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe, Sept. 1986, Düsseldorf/FRGDedicated to Prof. Dr. A. Bolte, Köln, for his 60th birthday     

2468例阴道镜检查与病理学诊断结果分析

用阴道镜活检２４６８例妇科门诊患者，在异常阴道镜图像中，白色上皮、腺口白环、白斑、点状血管、异形血管、镶嵌、明显癌及非典型增生的检出率分别为５．６％、１０．４％、１６．０％、１６．０％、１７．４％、２０．３％和７９．２％。腺口白环的癌及非典型增生的检出率为１０．４％。阴道细胞涂片中的Ⅲ、Ⅳ和Ⅴ级涂片中癌的检出率分别为２１．７％、６５．５％和９２％。涂片的级别与异常阴道镜图像有明显的关系。     

Definition and treatment of microcarcinoma of the cervix uteri

Patients with tumors without vessel invasion have a better prognosis than patients with tumors of the same size with vessel invasion. The depth of stromal infiltration should be measured from the epithelial surface. In patients with an infiltration less than 1 mm, conization will be sufficient treatment, but hysterectomy is necessary when the disease is more advanced. When the tumor has infiltrated into vessels, additional treatment including pelvic lymphadenectomy or external irradiation should be performed.