摘要:目的: 探讨联合LCT和高危型HPV检测对CIN宫颈治疗后的随访意义。 方法 :对200例LCT异常,高危型HPV阳性,阴道镜活检证实为CIN1~3的患者行LEEP治疗或宫颈冷刀锥切,治疗后进行严格随访,包括LCT和高危型HPV检测,阳性病例行组织学检查。 结果 :(1)所有病例经治疗后均无病变残留,其治愈率为100%。(2)从治疗后3个月起,CIN1组高危型HPV转阴率为100%。在随访的第3个月和6个月,CIN2~3组高危型HPV转阴率分别为7317%和9085%,显著低于CIN1组,差异有统计学意义(〖WTBX〗P ＜005)。(3)从随访12个月起,一直有2例病例持续HPV阳性,均为CIN3患者,但LCT和阴道镜检查未发现细胞学异常,继续随访。 结论 :CIN治疗后高危型HPV的转阴时间及转阴率与CIN的级别有关;高危型HPV持续阳性,但LCT和阴道镜检查无异常者可继续严格随访;LCT联合高危型HPV检测是CIN治疗后临床追踪随访的有效手段。Abstract: Objective: To investigate the Significance of LCT joint highrisk HPV testing for followup after CIN treatment. Methods : 200 cases that highrisk HPV infection were tested by realtime PCR and CIN1~3 were confirmed with LCT and colposcopy biopsy were considered. The patients were treated with LEEP treatment or cold knife conization. After treatment, all cases were strictly followed up with LCT and HPV test, and the patients with positive results were examined by histology. Results : 1) After treatment, there was no residual disease in all cases, the cure rate was 100%. 2) From 3 months after treatment, highrisk HPV negative rate was 100% in CIN1 cases. While at 3rd and 6th month after treatment, highrisk HPV negative rate in CIN2~3 cases were 7317% and 9085%, which were significantly lower than those in CIN1 cases,the difference was statistically significant. 3) From the 12th monthafter treatment, there are still two cases of sustained highrisk HPV positive but normal with LCT and colposcopy biopsy. All cases are still strictly followedup. Conclusion : After treatment, the negative rate and time of highrisk HPV concerned with the grade of the CIN; the patients with persistent positive highrisk HPV, but without abnormalities detected by LCT and colposcopy biopsy could continue to strictly follow up; LCT joint highrisk HPV detection is an effective clinical means for followup after CIN treatment.
ObjectiveTo systematically review the correlation between mTOR protein expression and different clinical pathological features as well as the response to radiotherapy and chemotherapy of cervical cancer. MethodsWe electronically searched databases including The Cochrane Library (Issue 1, 2015), PubMed, EMbase, CNKI, CBM, VIP and WanFang Data from inception to April 2015 to collect case-control studies investigating the correlation between mTOR protein expression and different clinical pathological features as well as the response to radiotherapy and chemotherapy of cervical cancer. Two reviewers independently screened literature, extracted data and assessed the risk bias of the included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 8 case-control studies involving 591 patients were included. Among these cases, 365 cases were in the cervical cancer group, 135 cases were in the cervical intraepithelial neoplasia (CIN) group, and 91 cases were in the normal cervix tissue group. The results of meta-analysis showed that:(1) Compared with the normal cervix tissue group, mTOR protein was overexpressed in the cervical cancer group (OR=24.14, 95%CI 4.47 to 130.35, P=0.000 2) and the CIN group (OR=4.71, 95%CI 2.15 to 10.33, P=0.000 1); Compared with the CIN group, mTOR protein was overexpressed in the cervical cancer group (OR=5.12, 95%CI 2.96 to 8.86, P<0.000 01). (2) Compared with the non-lymphnode-metastasis group, mTOR protein was overexpressed in the lymph node metastasis group (OR=3.29, 95%CI 1.61 to 6.69, P=0.001); Compared with the FIGO I group, mTOR protein was overexpressed in the FIGO Ⅱ group (OR=3.00, 95%CI 1.49 to 6.04, P=0.002); Compared with the radiotherapy and chemotherapy responsive group, mTOR protein was overexpressed in the non-response group (OR=15.64, 95%CI 3.17 to 77.15, P=0.000 7). In addition, there was no significant difference between the medium/high differentiation group and low differentiation group (OR=1.70, 95%CI 0.75 to 3.81, P=0.20). ConclusionmTOR protein expression is associated with cervical cancer, and mTOR protein overexpression was associated with lymph node metastasis, higher FIGO and non-response to radiotherapy and chemotherapy. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.
摘要:目的: 调查新疆地区维吾尔族与汉族子宫颈癌及癌前病变发病情况,分析宫颈癌高发原因。 方法 : 2000年1月至2005年12月新疆自治区人民医院妇产科门诊及病房行宫颈细胞学检查的维吾尔族、汉族妇女进行筛查,对宫颈病变阳性者(CINI以上)行病理组织学检查,对结果进行对比分析、综合评价。 结果 : 宫颈涂片人数共计23 205例,其中维吾尔族6 999例、汉族16 206例。宫颈病变阳性者237例,经阴道镜下病理活组织检查证实CINI以上(包括CINI、CINII、CINIII、原位癌、鳞癌、腺癌)病变人数173例,最小年龄31岁,原位癌(维吾尔族)、最大年龄76岁,宫颈磷癌(汉族)。维吾尔族105例(6069%)、汉族68例(3931%)。每年阳性例数中维吾尔族均高于汉族,其中2000年、2001年、2004年、2005年有极显著性差异(P lt;001),2002年、2003年有显著性差异(P lt;005),维吾尔族、汉族在各年龄组中的发病情况无显著性差异(P gt;005)。 结论 : 新疆地区宫颈癌及癌前病变的高发原因是由地区环境、医疗条件、医学发展、救助措施等因素综合作用的结果。Abstract: Objective: To investigate the incidence of cervical cancer and cervical precancerous lesion of uigur nationality and han nationality, in addition, to analysis the cause of cervical cancer’s high incidence. Methods : At first screen cervical cytology of Uigur and Han outpatient and inpatient of department of gynecology and obstetrics in the People’s Hospital of Xinjiang Uigur Autonomous Region from January 1, 2000 to December 31, 2004Secondly biopsy for those patients that cervix pathological change shows positive, then contrast analysis and comprehensive evaluation. Results : Cervix smears are 23205 samples. Uigur nation has 6999 samples and Han nation has 16206 samples. There are 237 patients whose cervix pathological changes shows positive. Among them 173 samples were over CINⅠ(include CINⅠ,CINⅡ,CIN Ⅲ,carcinoma in situ, squamous carcinoma and adenocarcinoma) through colposcopy. The youngest was 31 and diagnosed carcinoma in situ(Uigur), the eldest was 76 and diagnosed squamous carcinoma(Han).The samples of Uigur is 105(6069%) and Han is 68(3931%).The positive samples in Uigur is higher than Han each year, the incidence has extremely significant difference among 2000,2001 and 2004(P lt;001), while it has significant difference between 2002 and 2003 (P lt;005), but in each age group it has no significant difference between Uigur and Han (P gt;005). Conclusion : The high incidence of cervical cancer and cervical precancerous lesion in xinjiang is contribute to environment, medical condition, medical development and aid measures coaffect.
ObjectivesTo assess the methodological quality of clinical practice guidelines of cervical cancer in China published from 2014 to 2018.MethodsCNKI, WanFang Data, CBM, VIP, Medlive.cn, the National Guideline Clearinghouse, PubMed, The Cochrane Library and EMbase were searched for cervical cancer clinical practice guidelines published in China from January 1st, 2014 to December 31st, 2018. Four reviewers searched and selected the literature independently according to the inclusion and exclusion criteria and assessed the methodological quality of the included guidelines by using AGREE Ⅱ.ResultsA total of 9 guidelines were included. The average score for each area was: scope and purpose 75.47%, stakeholders’ involvement 35.09%, the rigor of development 43.70%, clarity of presentation 87.74%, applicability 80.76%, and editorial independence 0%.ConclusionsThe quality of cervical cancer clinical practice guidelines in China requires further improvement.
ObjectiveTo analyze the relative factors of lymph-nodes metastasis (LM) in patients with cervical cancer. MethodsThe clinico-pathological data of 136 patients with stageⅠ A-Ⅱ A of cervical cancer who underwent surgical therapy from January 2005 to December 2010 were retrospectively analyzed. The correlation between clinico-pathological parameters and LM was analyzed by univariable χ2 analysis and multivariable logistic analysis. ResultsThe total LM rate (LMR) was 14.0% (19/136). The rate of LM in obturator was the highest (63.2%), and then the rate between the external and internal iliac was 42.1%. The rate of deep inguinal lymph nodes and para-aortic lymph node was 0.0%. There was correlation between the clinic staging, depth of stromal invasion, histologic subtype, parametrial invasion, vaginal invasion and LM in univariable analysis (P<0.05). While in multivariable analysis, the correlation with LM was only existed between the clinic staging, histologic subtype, depth of stromal invasion and LM. ConclusionClinic staging, histologic subtype, depth of stromal invasion are high risk factors of LM.
Objective To investigate the expression of COX-2 in human cervical cancer and explore their relationship between the COX-2 expression and the clinicopathologic characteristic of cervical cancer. Methods The published studies were searched in the CBMdisc (1979 to 2009), CNKI (1979 to 2009), VIP (1989 to 2009) and WANFANG Database (1982 to 2009), and other relevant journals were also hand searched, to identify all the relevant case-control trials. The quality of the included studies was assessed. The Cochrane Collaboration’s software RevMan 4.2.10 was used to test the heterogeneity, overall effect and publication bias of the combined studies. Results A total of 9 studies were recruited. As for the positive rate of COX-2 expression, significant differences was tested between cervical cancer vs. normal cervical tissues, lymph node metastasi vs. non-lymph node metastasi, clinical stages I-II vs. clinical stages III-IV, cell differentiation G1 vs. cell differentiation G2-G3 and cervical squamous cell carcinoma vs. adenocarcinoma with OR (95%CI) at 28.03 (9.53 to 82.50), 5.16 (3.36 to 7.93), 0.53 (0.33 to 0.84), 3.11 (1.86 to 5.22) and 5.00 (2.68 to 9.35) respectively. Conclusions According to the domestic evidence, higher COX-2 expression might be associated with cervical cancer. However, more high quality case-control studies are expected for further study.
截止至2002年5月,现有早产治疗的临床证据如下: (1) 高危早产:在一些国家实施的RCT发现,在降低早产危险方面,加强产前保健与普通产前保健没有明显差异.包括5个RCT的1个系统评价发现,对有宫颈改变的妇女行宫颈环扎术有不同的结果,没有明确的结论.1个大样本的RCT发现,孕9～29周宫颈功能可能不全的妇女进行预防性宫颈环扎手术与不环扎相比,能明显降低早产(＜33孕周),但也会明显增加产褥感染的危险.另外4篇较小样本的RCT发现,孕10～30周、具各种早产高危因素的妇女,进行预防性宫颈环扎手术与不环扎相比,并不能降低早产(＜34孕周).1篇系统评价的2个RCT报告,对有宫颈改变的妇女进行环扎术有不同的结果,其中1个RCT发现其并不能明显降低早产(＜34孕周),而另外1个较小样本的RCT却发现宫颈环扎手术加卧床休息与单纯卧床休息比较,能明显降低34周前的早产.没有1个RCT证实行环扎术加卧床休息与单纯卧床休息相比,能降低围生儿死亡率. (2) 胎膜早破:1个系统评价发现,对胎膜早破的妇女,抗生素较安慰剂能明显延长孕周、降低新生儿发病率的危险,如新生儿感染、出生后氧疗、脑部超声异常等.阿莫西林加克拉维酸治疗与新生儿坏死性小肠结肠炎的发生率明显增加有关.一个基于1个RCT的系统评价发现,没有充足的证据证实羊膜腔灌注与不灌注比较能改善胎膜早破后的新生儿结局. (3) 先兆早产的治疗:①β-肾上腺素兴奋剂:1个系统评价发现,β-肾上腺素兴奋剂与安慰剂或不治疗相比,并不能明显降低围生儿死亡率、呼吸窘迫综合征及低体重儿(＜2 500 g)发生率,且与与安慰剂或不治疗相比,β-肾上腺素兴奋剂增加孕母副反应,如胸痛、心悸、呼吸困难、震颤、恶心、呕吐、头痛、高血糖、低钾血症.②钙离子通道拮抗剂: 没有关于钙离子通道拮抗剂与安慰剂比较的系统评价或RCT.1个系统评价发现,钙离子通道抑制剂与其它保胎药(主要是β-肾上腺受体兴奋剂)比较,能显著降低48 h内的早产分娩,减少因孕母副反应退出治疗和新生儿发病率.③硫酸镁:1个系统评价发现,硫酸镁与安慰剂比较,并不能明显降低孕36周前的早产率、围生儿死亡率、呼吸窘迫综合征的发生率.另一个系统评价发现,硫酸镁和其他宫缩抑制剂(β-肾上腺素兴奋剂、钙离子通道拮抗剂、前列腺素合成抑制剂、硝化甘油、酒精和葡萄糖注射剂)比较,并不能明显降低48 h内早产率(尽管结果没有差异).④垂体受体拮抗剂(阿托西班):1个系统评价纳入 2个RCT,对阿托西班和安慰剂治疗早产进行比较有不同的结果.较大样本的RCT发现,阿托西班较安慰剂能延长孕周,但阿托西班增加了孕28周以下的胎儿死亡率.另一个RCT发现,阿托西班增加了48 h内的早产.⑤前列腺素抑制剂(消炎痛):1个系统评价发现,消炎痛与安慰剂比较,能明显降低孕37周前的48 h和7天的早产率的证据有限.然而,同时发现消炎痛与安慰剂或不治疗相比,并不能明显降低围生儿死亡率、新生儿呼吸窘迫综合征、肺支气管发育不良、坏死性小肠结肠炎、新生儿败血症或低体重儿.但这个系统评价样本太小,尚不能发现有临床意义的差异. (4) 择期或非择期剖宫产对早产妇女治疗效果:1个系统评价结果发现,择期剖宫产较非择期剖宫产会增加孕母的发病率,却不能降低新生儿的发病率和死亡率.但尚不能证明此效果是否对新生儿有临床意义. (5) 改善早产妊娠结局的干预措施:①对早产者采用皮质类固醇:1个系统评价认为,对可能发生早产的妇女使用皮质激素较安慰剂或不处理能明显降低早产儿出生后呼吸窘迫综合征、新生儿死亡率和颅内出血的发生.②促甲状腺激素释放激素在早产中的运用:1个系统评价发现,在早产的高危妇女中,促甲状腺激素释放激素和类固醇激素联合应用与单用皮质类固醇激素比较,对新生儿结局的影响无明显差异,但会明显增加孕母和胎儿的不良反应.③抗生素:1个系统评价发现,抗生素与安慰剂比较,不能延长孕周、降低新生儿死亡率,但可降低孕母感染率.
目的:TCT(薄片液基细胞学检查)技术结合宫颈锥切在CIN(宫颈上皮内瘤样病变)的诊断及治疗应用,以及结合阴道CIN治疗后的临床观察。结果:TCT发现有不典型的细胞(ASCUS)再行阴道镜检查并取活检,病理发现CIN2-3级的患者要求保留子宫的行宫颈锥切。术后4~6个月随访,并行阴道镜复查及取活检。治愈率97%,术后一年行TCT检查为正常的细胞。结论:TCT技术在宫颈癌筛查方面是很好的手段,特别是发现CIN结合阴道镜及活检在诊断方面有很大的帮助。而宫颈锥切是保全子宫的一种手段,所切的宫颈送病理可以确诊CIN是治疗CIN很有效的方法。
目的:比较宫颈癌术后的三维适形放疗(3D-CRT)和调强放射治疗(IMRT)放射治疗计划的剂量学差异。方法:使用Elekta公司的PrecisePLAN Release2.11计划系统设计常规四箱形野(3D-CRT)和调强放疗(IMRT)计划。通过剂量体积直方图比较二者的放射物理参数,评价其应用价值.结果:IMRT计划中靶区平均剂量略高于3D-CRT计划中的相应值,其靶区适形度明显占优。同时,IMRT计划中的膀胱、直肠、小肠、股骨头等危险器官受到的平均剂量低于3D-CRT计划中的相应值,除右股骨头受到的平均剂量差异没有统计学意义,其它数据的差异都具有统计学意义。结论:对于宫颈癌术后患者的放射治疗,IMRT技术在保证肿瘤放射剂量的同时最大限度地减少了危险器官的照射剂量,减少了并发症的发生,应该更广泛地应用于临床。