LEEP刀宫颈环形电切术治疗宫颈上皮内瘤变102例临床观察

目的分析LEEP刀宫颈环形电切术治疗宫颈上皮内瘤变疗效。方法在200例宫颈上皮内瘤变患者中,102例患者采用LEEP刀宫颈环形电切术进行治疗,作为治疗组;98例患者采用传统冷刀宫颈锥切术进行治疗,作为对照组,分别比较了两种手术方法的手术时间、手术中出血量、切口愈合时间及手术前后病理变化。结果对照组和治疗组疗效相当,治疗组手术时间以及切口愈合时间出血量少,具有显著统计学意义(P<0.05)。结论该法术中出血量较少,优于冷刀宫颈锥切术,值得临床推广使用。     

保妇康栓联合LEEP锥切术治疗宫颈上皮内瘤变伴高危型HPV感染的疗效观察

目的 探讨保妇康栓联合LEEP锥切术治疗宫颈上皮内瘤变（CIN）伴高危型HPV感染的临床疗效。方法 选取2015年1月至2016年1月收治的CIN合并HPV感染患者120例,按照随机数字法分为观察组和对照组,每组60例,对照组给予LEEP术进行治疗,观察组在对照组基础上于术后给予保妇康栓进行治疗,观察并比较两组患者阴道出血量及出血时间、阴道排液量及时间、宫颈创面愈合时间,并对术后3个月、6个月CIN治疗效果及HPV清除效果进行评价。结果 观察组患者阴道出血量及出血时间、阴道排液量及时间、宫颈创面愈合时间均显著小于对照组（t=13.29、6.61、11.46、6.01、4.78,P<0.05）,且盆腔疼痛发生率显著低于对照组（χ2=11.64,P<0.05）。观察组患者术后3个月、术后6个月宫颈细胞学检查CIN治愈率为86.7%、96.7%,分别高于对照组的71.7%、81.7%（χ2=4.09、6.99,P<0.05）。观察组患者术后3个月、6个月HPV转阴分别为36例、47例,转阴率分别为60.0%、78.3%,对照组术后3个月、6个月HPV转阴分别21例、28例,转阴率分别为35.0%、46.7%。观察组患者术后3个月、6个月的HPV转阴率均显著高于对照组（χ2=5.64、12.84,P<0.05）。且观察组患者术后3个月、6个月单一基因型及混合基因型HPV转阴率也均显著高于对照组（χ2≥3.96,P<0.05）。结论 保妇康栓联合LEEP术可显著改善CIN伴高危型HPV感染患者术后临床症状,提高CIN治愈率和HPV转阴率。     

宫颈上皮内瘤变患者阴道微生态状况与LEEP术后预后关系

目的 研究宫颈上皮内瘤变（CIN）患者阴道微生态状况及LEEP术后阴道微生态状况的变化特点,分析阴道微生态状况与CIN患者预后的关系。方法 回顾性分析2016年1月至2018年1月温州医科大学定理临床学院122例高危型人乳头瘤病毒（hr-HPV）阳性的CIN患者LEEP术治疗前后阴道微生态的变化特点。结果 LEEP术后菌群密集度Ⅱ~Ⅲ级（74.59%）、多样性Ⅱ~Ⅲ级（68.03%）、乳酸分级Ⅰ~Ⅱa级（70.49%）出现增多,需氧菌性阴道病（AV）（9.84%）、细菌性阴道病（BV）（14.75%）、外阴阴道假丝酵母菌病（VVC）（12.30%）以及滴虫性阴道炎（2.46%）的检出率降低和pH值（4.2±0.5）降低,与术前比较差异具有统计学意义（均P<0.05）;术后复诊hr-HPV阳性CIN患者菌群密集度Ⅱ~Ⅲ级（35.00%）、多样性Ⅱ~Ⅲ级（40.00%）、乳酸分级Ⅰ~Ⅱa级（25.00%）低于hr-HPV阴性CIN患者,AV（30.00%）、BV（35.00%）、VVC（30.00%）检出率,pH值（4.9±0.4）高于hr-HPV阴性CIN患者,差异有统计学意义（均P<0.05）。结论 阴道微生态失衡可降低宫颈免疫力,促进CIN进展、癌变,改善阴道微生态可抑制hr-HPV的感染,抑制宫颈细胞的异常增生、癌变。     

宫颈上皮内瘤变治疗前后人乳头状瘤病毒载量的临床研究

目的:探讨宫颈上皮内瘤变(CIN)治疗前后人乳头状瘤病毒(HPV)载量与预后的意义.方法:从2006年6月～2009年9月间在新疆维吾尔自治区人民医院妇科门诊和妇科病房就诊的190例CIN患者,经宫颈环形电切术(LEEP)或宫颈冷刀锥切术治疗后进行1年随访,检测治疗前后HPV的载量,对病灶持续存在和复发进行分析.结果:CIN患者经LEEP或宫颈冷刀锥切术治疗后HPV平均载量较治疗前均显著降低(P＜0.01).随着HPV病毒载量持续时间越长,病变的持续存在率、复发率越高.结论:LEEP或宫颈冷刀锥切能显著降低CIN患者HPV载量,病毒载量影响疾病预后,其研究对随访和预后都有指导意义.     

LEEP刀治疗宫颈病变的临床疗效分析

目的探讨LEPP刀治疗宫颈病变的临床疗效。方法将我院收治的172例宫颈病变患者作为研究对象,采用分组方式进行治疗。观察组86例应用LEEP刀对病变组织进行切除,对照组采用常规手术方式进行治疗,并对两组患者的手术时间、出血量、并发症等以及术后2年的预后恢复情况进行比较。结果观察组平均手术时间显著短于对照组(P0.05),术中出血量及并发症发生率均显著少于对照组(均P0.05)。术后随访,观察组预后恢复情况优于对照组。结论 LEPP刀治疗宫颈病变的手术时间短,出血少,术后反应小,见效快,患者预后好,是治疗宫颈病变安全有效的方法,值得推广应用。     

宫颈特殊染色技术对子宫颈癌及宫颈上皮内瘤变初筛的临床研究

目的:探讨宫颈特殊染色技术筛查方法对宫颈癌及癌前病变的筛查意义。方法:本研究通过对1963例就诊我院妇科门诊的患者进行宫颈特殊染色检查(FRD),以组织病理学检查结果为标准,分析FRD宫颈特殊染色的临床意义。结果:1963例患者行宫颈特殊染色检查及对初筛阳性患者行阴道镜下活检,根据活检病理结果进行分析,CINI阳性率80.77%℅,CINII81.25%,CINIII100%℅,侵润癌100%,总阳性率90.50%。结论:利用亚甲蓝显色和醋酸白化反应双重定位及指示,不仅可提高宫颈癌及癌前病变的检出率,而且操作简便,判读容易,结果快速,成本低廉。     

宫颈上皮内瘤变与宫颈微生物群落结构的相关性

目的分析宫颈上皮内瘤变与宫颈微生物群落结构的相关性。方法选取2017年1月至2018年10月于我院就诊的253例女性进行回顾性分析,根据是否患有宫颈上皮内瘤变分为CIN组(86例)及对照组(167例)。采集纳入对象的宫颈菌群并提取细菌基因组DNA,对细菌16S rRNA V3、V4区片段进行PCR扩增,并采用Illuminate Miseq测序平台对PCR产物进行测序,分析两组对象宫颈微生物群落结构,并分析患者宫颈微生物群落结构与宫颈上皮内瘤变的相关性。结果两组对象宫颈微生物群落的Simpson指数及Shannon指数比较差异无统计学意义(t=1.474、1.636,P0.05),而CIN组的Chao指数及ACE指数均高于对照组(t=9.213、10.420,P0.05)。16S rRNA分析显示放线菌是宫颈部位的主要菌群。CIN组女性宫颈微生物群落中放线菌、奇异菌属、放线菌门、阴道奇异菌及奇异变形菌占主要优势(LDA4log10),对照组中杆菌、厚壁菌门等占主要优势。Spearman相关分析示卷曲乳杆菌、惰性乳杆菌、格氏乳杆菌、詹氏乳杆菌与宫颈上皮内瘤变呈负相关,而加特纳菌、阴道奇异菌、普雷沃氏菌、粪球菌与宫颈上皮内瘤变呈正相关(均P0.05)。结论 CIN女性宫颈菌群与健康女性存在明显差异,其中卷曲乳杆菌、惰性乳杆菌、格氏乳杆菌、詹氏乳杆菌与宫颈上皮内瘤变呈负相关,而加特纳菌、阴道奇异菌、普雷沃氏菌、粪球菌与宫颈上皮内瘤变呈正相关。     

壮药金回合剂治疗宫颈上皮内瘤变、HPV 感染合并宫颈炎症 的疗效分析

目的:探讨壮药金回合剂治疗宫颈上皮内瘤变、HPV感染合并宫颈炎症的疗效。方法:将符合纳入标准的宫颈上皮内瘤变、HPV感染合并宫颈炎症患者,随机分为2组,各35例。观察组:壮药金回合剂宫颈上药,qod;对照组:安达芬拴宫颈上药,qod,比较两组临床疗效。结果:CINⅠ,观察组有效率为89.29%,对照组为65.38%,差异有显著性(P<0.05);而CINⅡ差异无显著性。HPV转阴,观察组转阴率为68.57%,对照组为45.71%,差异有显著性(P<0.05);宫颈炎改善情况比较,观察组有效率为94.29%,对照组为77.14%,差异有显著性(P<0.05)。全部患者在治疗过程中均未发现需要注意的不良反应。结论:壮药金回合剂治疗宫颈上皮内瘤变、HPV感染合并宫颈炎症,可恢复宫颈屏障功能,HPV转阴率高,疗效好。     

保妇康栓联合LEEP治疗宫颈糜烂的疗效观察

目的:探讨LEEP联合保妇康栓治疗宫颈糜烂的临床疗效.方法:106例宫颈糜烂患者随机分为对照组(51例)与治疗组(55例),其中对照组采用LEEP治疗,治疗组采用LEEP联合保妇康检治疗.观察比较两组疗效、阴道排液、术后出血和创面愈合情况.结果:治疗组阴道排液量、术后出血时间、出血例数及创面愈合时间与对照组比较差异均有统计学意义(P＜O.05或P＜0.01);治疗组总有效率与对照组无差异(P＞0.05),但92.7%的治愈率显著高于对照组78.4%的治愈率,差异具有统计学意义(P＜0.05).结论:LEEP联合保妇康栓治疗宫颈糜烂疗效显著,优于单独LEEP治疗.     

宫颈电环切除术与冷刀锥切术治疗宫颈上皮内瘤变的临床比较

目的:比较宫颈电环切除术(LEEP)与冷刀宫颈锥切术治疗宫颈上皮内瘤变(CIN)的临床疗效。方法:回顾性分析分别行LEEP(96例)与冷刀锥切术(78例)治疗的CINⅡ-Ⅲ级患者的临床资料,比较两组患者手术时间、术中出血量、脱痂期出血量及切口愈合时间。结果:LEEP组患者术中出血量(13.5±2.6 mL)、手术时间(12.8±1.9 min)分别少于或短于冷刀宫颈锥切组(26.4±3.7 mL;24.9±2.5 min)(P0.01),两组患者脱痂期出血量、术后切口愈合时间无统计学差异。结论:LEEP治疗CINⅡ-Ⅲ级患者较冷刀锥切术治疗术中出血少,手术时间短,值得临床推广。     

Fractal Analysis of Cervical Intraepithelial Neoplasia

Introduction

Cervical intraepithelial neoplasias (CIN) represent precursor lesions of cervical cancer. These neoplastic lesions are traditionally subdivided into three categories CIN 1, CIN 2, and CIN 3, using microscopical criteria. The relation between grades of cervical intraepithelial neoplasia (CIN) and its fractal dimension was investigated to establish a basis for an objective diagnosis using the method proposed.

Methods

Classical evaluation of the tissue samples was performed by an experienced gynecologic pathologist. Tissue samples were scanned and saved as digital images using Aperio scanner and software. After image segmentation the box counting method as well as multifractal methods were applied to determine the relation between fractal dimension and grades of CIN. A total of 46 images were used to compare the pathologist''s neoplasia grades with the predicted groups obtained by fractal methods.

Results

Significant or highly significant differences between all grades of CIN could be found. The confusion matrix, comparing between pathologist''s grading and predicted group by fractal methods showed a match of 87.1%. Multifractal spectra were able to differentiate between normal epithelium and low grade as well as high grade neoplasia.

Conclusion

Fractal dimension can be considered to be an objective parameter to grade cervical intraepithelial neoplasia.     

阴道镜检查在宫颈上皮内瘤样病变诊断中的价值

目的：探讨阴道镜检查在宫颈上皮内瘤样病变诊断中的价值。方法：回顾性分析我院自2004年10月至2006年6月528例阴道镜检查结果。结果：528例中行阴道镜和病理检查的有321例,阴道镜下诊断宫颈上皮内瘤样病变（CIN）76例,经病理确诊CIN51例,诊断符合率为67.11%;这两组用t检验,P〉0.05无统计学意义。同时行阴道镜检查和宫颈新柏氏膜式液基层细胞学检测（简称TCT）的324例患者进行分析表明,随着细胞学诊断分级的升高,阴道镜正常图像比例逐渐减少,异常图像比例逐渐增多。结论：阴道镜作为一种宫颈癌前病变和早期癌的重要方法之一,越来越受到临床医师的重视,它具有不与患者直接接触,对患者无任何损害,不造成任何不良影响,价格适中等优点,阴道镜可作为我国目前CIN和早期宫颈癌筛查的最佳方法,但最后确诊仍依靠病理学检查。     

p16和bcl-2在宫颈上皮瘤样病变及宫颈癌中的表达

目的探讨p16和bcl-2表达产物在宫颈上皮瘤样病变及宫颈癌中表达的意义。方法对正常宫颈鳞状上皮、宫颈上皮内瘤变(CIN)和宫颈癌组织共69例,采用免疫组织化学EliVision法,对宫颈癌变过程中p16和bcl-2蛋白进行研究,将结果进行统计分析。结果p16蛋白在CIN中的表达高于正常宫颈上皮(P<0.01),在宫颈癌中的表达也高于正常宫颈上皮(P<0.01),且高于CIN中的表达(P<0.05);bcl-2蛋白在CIN中的表达高于正常宫颈上皮(P<0.01),在宫颈癌中的表达也高于正常宫颈上皮(P<0.01),但与CIN中表达无差异。p16和bcl-2两种蛋白在CIN和宫颈癌中的表达无明显差异。结论p16和bcl-2蛋白的表达与宫颈癌的发生有关,提示这两种蛋白有可能作为高危人群早期筛查的一种免疫组化指标。     

阴道镜活检联合LEEP 术诊治宫颈病变的疗效分析

目的:探讨阴道镜活检联合宫颈环形电切术(LEEP术)诊治宫颈病变的疗效.方法:对354例宫颈病变患者在阴道镜下多点活检后行LEEP术治疗,并做病理组织学诊断,观察患者的手术时间、术中出血量及治疗效果,比较两种方法取材的病理组织学诊断结果.结果:LEEP术的平均手术时间长约6.76.7± 3.5 min,术中出血量＜20 mL.2个月后患者复查,成功率为93.8％(332/354例),经二次手术全部治愈,并发症少.从病理组织学诊断结果来看,与LEEP术相比,阴道镜下活检的炎症检出率高,宫颈上皮内瘤变的检出率低,但差异均无显著统计学意义(P＞0.05).结论:根据阴道镜活检结果,针对性使用LEEP术,密切随访,是诊治宫颈病变的有效方法.     

The Cytological Prediction of Cervical Intraepithelial Neoplasia In Colposcopically Directed Biopsies

The tissue sections and preceding cervical smears of 1262 women who had colposcopic cervical biopsies were reviewed and the reports correlated. Close correlation between the cytological and histological findings, to within one histological grade of cervical intraepithelial neoplasia (CIN), was noted in 86% of cases. However, the biopsy was negative, or contained evidence of wart virus infection only, in 24% of cases where dyskaryotic cells had been observed in the cervical smear. Of particular concern was the fact that negative histological findings were recorded in 13% of cases where the smear contained cells showing a moderate dyskaryosis and in 1.26% of cases where the smear showed severe dyskaryosis. This suggests that colposcopically directed biopsies do not always reflect the underlying pathological changes in the cervix. Management of these cases is discussed. In 45 women with a normal cervical smear prior to biopsy, histology revealed seven cases of CIN 3 and one case of invasive squamous carcinoma. This indicates that referral for colposcopy is advisable whenever there is clinical suspicion of cancer, even if the cervical smear report is normal.     

宫颈电环切除术治疗76例子宫颈上皮内瘤样病变的分析

目的:探讨子宫颈电环切除术(LEEP)治疗子宫颈上皮内瘤样病变(CIN)的价值。方法:回顾性分析2004年10月至2006年9月收治的76例CIN患者行LEEP术治疗情况。结果:本研究的CIN 76例中CIN-Ⅰ37例,CIN-Ⅱ7例、CIN-Ⅲ2例,cIN-Ⅰ-Ⅱ21例,CIN-Ⅱ-Ⅲ9例。76例CIN患者行LEEP术治疗后最长的随访2年,最短的三个月。术后三个月新柏氏膜式液基层细胞学检测(Thin-prep Cytolosy Test,TCT)正常者76例(100%),人乳头瘤状病毒(HPV)转阴者75例(98.68%),阴道镜检查正常者74例(97.37%)。本组治愈率为98.68%,复发率为0例。结论:LEEP术治疗CIN具有以下优点:①安全、快捷又出血量少;②手术时间短,可在门诊进行手术;③可达到传统电刀达不到的非常精细的手术效果;④不易产生传统电刀切割时组织被拉长、碳化现象,可以得到不影响病理检查的完好的组织标本,对临近组织损伤小,治疗的同时能进行诊断;⑤疼痛少,不易留下瘢痕,感染少;⑥对宫颈损伤小,可以保留生育功能,更适合年轻患者。⑦避免了二次手术和过度治疗。但术后长期的规范随访,早期发现CIN复发及宫颈癌至关重要。     

Prevalence and Predictors of Colposcopic-Histopathologically Confirmed Cervical Intraepithelial Neoplasia in HIV-Infected Women in India

Background

Prevalence estimates of cervical intraepithelial neoplasia (CIN) among HIV-infected women in India have been based on cervical cytology, which may have underestimated true disease burden. We sought to better establish prevalence estimates and evaluate risk factors of CIN among HIV-infected women in Pune, India using colposcopy and histopathology as diagnostic tools.

Methodology

Previously unscreened, non-pregnant HIV-infected women underwent cervical cancer screening evaluation including standardized diagnostic colposcopy by a gynecologist. Histopathologic confirmation was conducted among consenting women with clinical suspicion of CIN. The prevalence of CIN was evaluated by a composite diagnosis based on colposcopy and histopathology results. Multivariable ordinal logistic regression analysis was conducted to determine independent predictors of increasing severity of CIN.

Results

The median age of the n = 303 enrolled HIV-infected women was 30 years (interquartile range, 27–34). A majority of the participants were widowed or separated (187/303, 61.7%), more than one-third (114/302, 37.7%) were not educated beyond primary school, and nearly two-thirds (196/301, 64.7%) had a family per capita income of <1,000 Indian Rupees (∼US$22) per month. Cervical high-risk HPV-DNA was detected in 41.7% (124/297) of participants. The composite colposcopic-histopathologic diagnoses revealed no evidence of CIN in 220 out of 303 (72.6%) women, CIN1 in 33/303 (10.9%), CIN2 in 31/303 (10.2%), CIN3 in 18/303 (5.9%) and 1 (0.3%) woman was diagnosed with ICC. Thus, over a quarter of the participants [83/303: 27.7% (95% CI: 22.7–33.1)] had ≥CIN1 lesions and a sixth [50/303: 16.5% (95% CI: 12.2–21.9)] had evidence of advanced (≥CIN2) neoplastic disease. The independent predictors of increasing severity of CIN as revealed by a proportional odds model using multivariable ordinal logistic regression included (i) currently receiving antiretroviral therapy [adjusted odds ratios (aOR): 2.24 (1.17, 4.26), p = 0.01] and (ii) presence of cervical high-risk HPV-DNA [aOR: 1.93 (1.13, 3.28), p = 0.02].

Conclusions

HIV-infected women in Pune, India have a substantial burden of cervical precancerous lesions, which may progress to invasive cervical cancer unless appropriately detected and treated. Increased attention should focus on recognizing and addressing this entirely preventable cancer among HIV-infected women, especially in the context of increasing longevity due to antiretroviral therapy.