宫颈烧灼治疗后应用MEBO换药治疗体会

目的：总结笔者一年来对宫颈疾病烧灼治疗后应用MEBO换药治疗的体会。方法：对65例患者分两组，应用MEBO创面换药治疗及传统方法治疗进行对比。结果：采用MEBO创面治疗效果明显优于传统治疗。结论：采用MEBO处理创面效果良好。     

Immunohistochemistry as a diagnostic aid in cervical pathology

As with biopsies from other sites in the female genital tract, immunohistochemistry is now being increasingly used in cervical pathology as an aid to diagnosis. In this review, I discuss applications of immunohistochemistry in diagnostic cervical pathology with a particular focus on recent developments. It is emphasised that immunohistochemistry is to be used as an adjunct to routine morphological examination and that no marker is totally specific or sensitive for a given lesion. Although much of this review focuses on glandular lesions, the value of markers, such as MIB1 and p16, in the assessment of pre-invasive cervical squamous lesions is discussed. In the broad field of cervical glandular lesions, topics covered include: the value of markers such as MIB1, p16 and bcl-2 in distinguishing adenocarcinoma in situ and glandular dysplasia from benign mimics; markers of mesonephric lesions, including CD10; markers of value in the diagnosis of minimal deviation adenocarcinoma, such as HIK1083; markers of value in distinguishing metastatic cervical adenocarcinoma in the ovary from primary ovarian endometrioid or mucinous adenocarcinoma. Rarely ectopic prostatic tissue occurs in the cervix, which can be confirmed by positive staining with prostatic markers. A panel of markers, comprising oestrogen receptor, vimentin, monoclonal carcinoembryonic antigen and p16, is of value in distinguishing between a cervical adenocarcinoma and an endometrial adenocarcinoma of endometrioid type. Markers of use in the diagnosis of cervical neuroendocrine neoplasms, including small cell and large cell neuroendocrine carcinoma, are discussed. It is stressed that small cell neuroendocrine carcinomas may be negative with most of the commonly used neuroendocrine markers and this does not preclude the diagnosis. p63, a useful marker of squamous neoplasms within the cervix, is of value in distinguishing small cell neuroendocrine carcinoma (p63 negative) from small cell squamous carcinoma (p63 positive) and in confirming that a poorly differentiated carcinoma is squamous in type.     

Mesonephric adenocarcinoma of the uterine cervix with rare lung metastases: A case report and review of the literature

BACKGROUND Mesonephric adenocarcinoma(MNA)of the female reproductive system is a rare tumor arising from remnants of the mesonephric duct,which is mainly located in the cervix.MNA often occurs in adult women.Due to the rarity of the disease and few reports,the specific clinical features have not been established.CASE SUMMARY We present a case of a cervical MNA in a 48-year-old woman with an incidental intra-operative diagnosis who received postoperative chemotherapy.Rare lung metastases were detected during follow-up.The existing literature is reviewed.CONCLUSION The clinical manifestations,pathological characteristics,diagnosis,treatment,and prognosis of MNA have been summarized through the review of the existing literature and the case in this paper.Due to the rarity of this disease,it is very important for the research of MNA in the future.     

Type B Laparoscopic Radical Trachelectomy With Pelvic Lymphadenectomy for Early Cervical Cancer

Study Objective

To demonstrate the technique of laparoscopic radical trachelectomy (LRT) and laparoscopic pelvic lymphadenectomy for early cervical cancer.

宫颈环扎术并发症

宫颈环扎术是治疗宫颈机能不全的唯一有效方法,其并发症发生率低,相关报道少,严重并发症罕见。最常见的并发症包括胎膜早破、绒毛膜羊膜炎、子宫内膜炎、围手术期出血、宫颈裂伤、环扎线或环扎带移位等,少见的并发症有膀胱宫颈瘘、输尿管宫颈瘘等,经阴道环扎的并发症较经腹环扎多。并发症的发生率因宫颈环扎的时机及适应证的不同而异。并发症常随孕周的增加及宫颈的扩张而增多,当胎膜破裂或宫颈扩张时行环扎术会增加并发症的发生风险。故应严格掌握适应证与禁忌证,选择适合的手术时机。已证明宫颈环扎的穿刺点和环扎带的位置直接影响妊娠结局,环扎带越接近宫颈内口效果越好。宫颈环扎后一般要限制体力活动,适当卧床休息,若子宫的敏感性增高给予孕酮和保胎药物,有感染病史及感染迹象者给予抗生素,重视阴道感染的筛查与治疗,密切监测母胎情况,关注宫颈环扎可能出现的并发症。开腹或腹腔镜环扎需剖宫产分娩,如有产兆,应即刻施术,避免发生宫颈裂伤或子宫破裂。     

子宫颈储备细胞增生与CD44v5在其细胞中的表达

目的研究宫颈储备细胞增生时的形态表现及其免疫组织化学特点,为探讨癌变机理提供依据。方法观察238例宫颈良性疾病中储备细胞增生的发生率及其多种形态表现;用免疫组织化学法检测54个病例中CD44v5的表达情况。结果与结论1．在多种宫颈良性疾病中储备细胞普遍呈增生状态;2．增生细胞的形态可分为4型：大细胞型、小细胞型、透明细胞型及梭形细胞型;3．CD44v5在各型储备细胞中100％均呈强阳性表达。多种宫颈良性疾病中存在储备细胞增生;储备细胞可能来源于间质。     

宫颈淋巴瘤样病变与宫颈淋巴瘤的鉴别

目的探讨宫颈淋巴瘤样病变和宫颈淋巴瘤的临床病理特点及免疫球蛋白重链（IgH）基因重排在两者鉴别诊断上的价值。方法对10例宫颈淋巴瘤样病变和16例宫颈淋巴瘤进行临床资料分析和组织病理学观察,以免疫组织化学（EnVision法）检测B、T淋巴细胞标记物和免疫球蛋白轻链（κ,λ）的表达,并应用半套式聚合酶链反应方法检测了4例淋巴瘤样病变和4例淋巴瘤中IgH基因重排的情况。结果宫颈淋巴瘤样病变患者年龄24—54岁（中位年龄43岁）,临床多表现为宫颈糜烂或息肉,镜下观察可见表浅分布的、局灶或弥漫性免疫母细胞样大细胞浸润,伴淋巴细胞转化成熟现象和多型性炎性细胞浸润（多量成熟浆细胞、嗜酸性粒细胞、中性粒细胞）。宫颈淋巴瘤患者年龄28—78岁（中位年龄58岁）,临床表现为宫颈肿块或弥漫性宫颈肥大,镜下观察示12例弥漫性大B细胞淋巴瘤和4例滤泡性淋巴瘤,二者组织学形态分别以弥漫分布、形态单一的肿瘤性大淋巴细胞浸润和肿瘤性滤泡形成为特点,病灶中少有多型性炎性细胞浸润,也不出现淋巴细胞转化成熟现象。宫颈淋巴瘤样病变中,免疫母细胞样大细胞κ和λ染色结果欠满意。4例宫颈淋巴瘤病例和2例宫颈淋巴瘤样病变中检出单克隆性IgH基因重排。结论宫颈淋巴瘤样病变和淋巴瘤主要依据不同的临床和病理形态特点相互区分。IgH基因重排检测对于二者鉴别有帮助,但需注意部分良性病变也有单克隆性淋巴细胞增生。     

p53 Arg72Pro多态性与新疆维吾尔族和汉族妇女宫颈癌发生的相关性

目的探讨p53 Arg72Pro多态性与新疆维吾尔族、汉族妇女宫颈癌发生及与HPV感染宫颈癌的相关性。方法采用聚合酶链反应-限制性片段长度多态性分析（PCR—RFLP）方法检测152例维吾尔族妇女宫颈癌组织及110例非癌宫颈组织、120例汉族妇女宫颈癌组织及122例非癌宫颈组织中p53 Arg／Arg、Pro／Pro、Arg／Pro三种基因型的分布。结果比较维吾尔族妇女宫颈癌和非癌对照组中p53基因型总构成比,差异有统计学意义（χ^2=7．196,P〈0．05）,Arg／Arg所占比例在维吾尔族妇女宫颈癌组高于非癌对照组。比较汉族妇女宫颈癌和非癌对照组中p53基因型总构成比,差异有统计学意义（χ^2=8．231,P〈0．025）,Pro／Pro所占比例在汉族妇女宫颈癌组高于对照组。比较维吾尔族妇女宫颈癌中HPV16阳性组和阴性组p53基因型构成比,差异有统计学意义（χ^2=7．177,P〈0．05）,Arg／Arg所占比例在HPV16阳性组高于阴性组。结论p53 Arg／Arg基因型可能是新疆维吾尔族妇女宫颈癌发生的遗传易感因素,且与维吾尔族妇女HPV相关宫颈癌的发生有关。p53 Pro／Pro基因型可能是新疆汉族妇女宫颈癌发生的遗传易感因素。新疆维吾尔族妇女与汉族妇女宫颈癌的发生可能存在遗传易感性方面的差异。     

HIF-1α和VEGF在宫颈癌中的表达及相关性研究

目的：探讨缺氧诱导因子-1α（HIF-1α）及血管内皮生长因子（VEGF）在宫颈癌发生发展过程中蛋白表达情况及两者的相关性。方法：应用免疫组织化学S-P方法检测10例正常宫颈（NCE）、18例宫颈上皮内瘤变（CIN）、77例宫颈癌（ICC）组织中HIF-1α和VEGF蛋白的表达情况。结果：在正常宫颈上皮、宫颈上皮内瘤变组织、宫颈癌（Ⅰ—ⅡA期）组织中，HIF．1d蛋白的阳性表达率分别是0．00％、33．33％、70．13％（P〈0．05），VEGF蛋白的阳性表达率分别为10．00％、44．44％、74．00％（P〈0．05）；且随HIF—1α表达增强，VEGF阳性表达率递增，两者呈正相关（P〈0．05）。结论：HIF-1α及VEGF的表达与宫颈癌的发生发展密切相关且两者呈正相关，HIF-1α蛋白可能以转录激活的形式上调VEGF基因的表达，诱导血管生成，促进了宫颈癌的发生发展。     

Epidemiology of cervical cancer in Colombia

Worldwide, cervical cancer is the third most common cancer in women, and the first or second most common in developing countries. Cervical cancer remains in Colombia the first cause of cancer mortality and the second cause of cancer incidence among women, despite the existence of screening programs during the last 3 decades. Bucaramanga, Manizales and Cali reported rates around 20 per 100,000and Pasto 27 per 100,000. The Cali cancer registry has reported a progressive decrease in the age standardized incidence and mortality rates of cervical cancer over the past 40 years. Reasons for the decline in incidence and mortality of cervical cancer are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs. Human papilloma Virus is the main cause of cervical cancer, HPV natural history studies have now revealed that HPVs are the commonest of the sexually transmitted infections in most populations. Most HPV exposures result in spontaneous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancerous and cancer. HPV 16 and 18 account for 70% of cervical cancer and the 8 most common types. (HPV 16, 18, 45, 33, 31, 52, 58 and 35) account for about 90% of cervical cancer. Case-control studies also allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with herpes simplex type 2 and Chlamydia trachomatis. The demonstration that infection with certain types of human papillomavirus (HPV) is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts: (i) Primary prevention by the use of prophylactic HPV vaccines; and (ii) secondary prevention by increasing the accuracy of cervical cancer screening.