目的:探讨妊娠相关性宫颈癌的早期诊断、治疗和预后。方法:结合文献回顾分析我院2000年至2007年收治的13例妊娠相关性宫颈癌的诊治经过和预后。结果:妊娠相关性宫颈癌分化程度低，癌灶体积大，早期盆腔淋巴结转移率高，产褥期宫颈癌预后差。结论:宫颈细胞学检查应列为首次产检常规项目；妊娠期宫颈原位癌在密切随诊前提下可暂不予处理，待分娩后6~8周活检确认病变性质后，再采取相应治疗措施；新辅助化疗同样可为晚期别的妊娠相关性宫颈癌争取手术时机。
【摘要】 目的 探讨中晚期宫颈癌术前动脉灌注化疗栓塞的临床价值。 方法 选择2005年6月-2009年12月35例经阴道镜活检确诊为宫颈癌临床分期Ⅱa~Ⅲb期宫颈癌患者，术前行1次子宫动脉化疗栓塞，化疗药物为博莱霉素（BLM）+顺铂（DDP）+环磷酰胺（CTX），栓塞剂为超液化碘油加明胶海绵颗粒。介入治疗后14~20 d行子宫全切加淋巴结清扫术。观察动脉灌注化疗栓塞前后肿块的大小变化、术中肿块粘连状况及出血量的多少。 结果 经介入治疗后肿块缩小32例：完全缓解（CR）3例、部分缓解（PR）29例，肿块无变化（NC）2例，进展（PD）1例，治疗有效率为91.4%。31例选择了手术治疗，手术率为88.6%。术中肿块粘连状况：无粘连24例，轻度粘连6例，中度粘连1例。术中出血量：≤100 mL 7例，100~200 mL 18例，200~400 mL 6例。 结论 中晚期宫颈癌术前动脉灌注化疗栓塞能有效地提高肿瘤切除率，降低手术风险。【Abstract】 Objective To evaluate the clinical value of preoperative transarterial chemoembolization for advanced cervical cancer. Methods A total of 35 patients with pathologically proved cervical cancer (from stage Ⅱa to Ⅲb) from June 2005 to December 2009 received preoperative transarterial chemoembolization once. Bleomycin, cisplantin and cytoxan were infused via bilateral uterine arteries, followed by arterial emboliezation with super-liquefaction iodipin and gel foam particles as embolic agent. Radical surgery was performed on the patients after 14-20 days. Volume change of mass, accretion state and haemorrhagia amount during the operation were analyzed. Results The masses deflated in 32 cases: complete response (CR) in 3, and partial response (PR) in 29. No change (NC) was seen in 3 cases. The effective rate was 91.4%. In 31 cases who underwent the operation, the operability was 88.6%, in whom non-accretionin was in 24, light accretion was in 6 and medium accretion was in 1. Haemorrhagia amount was less than 100 mL in 11 cases, 100-200 mL in 21cases, and 200-1 400 mL in 3 cases. Conclusion Preoperative chemoembolization can elevate exairesis rate and depress the operative risk effectively.
Objective To investigate the efficacy and safety of neo-adjuvant chemotherapy for stage ⅠB2-ⅡB cervical cancer. Methods From June 2012 to December 2014, 66 patients with stage ⅠB2-ⅡB cervical cancer were selected and treated by PT (cisplatin/ carboplatin and taxol/docetaxel) as neo-adjuvant chemotherapy prior to surgery. Neo-adjuvant chemotherapy response and toxicity were collected and analyzed. Results The extinctive condition of tumor by neo-adjuvant chemotherapy: the complete remission rate was 10.6% (7/66), partial remission rate was 59.1% (39/66), and the total effective rate was 69.7%. The main toxicities were myelosuppression (59.1%, 39/66) and gastrointestinal reactions (33.3%, 22/66). The toxicities could be tolerated or relieved by prevention and treatment. The effective rate of chemotherapy for cervical squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma was 72.6%, 33.3% and 0%, respectively, with significant differences among the three types (P<0.05). The effective rate of chemotherapy for high, medium and low differentiated cervical cancer was 100.0%, 77.3% and 55.9%, respectively, with significant differences among the three degrees (P<0.05). Conclusions Neo-adjuvant chemotherapy is proved to be a safe and effective complementary treatment for most patients with locally advanced cervical cancer. Due to the limitation of sample size, the correlations between therapeutic effect and tumor differentiation degree and between therapeutic effect and pathological type need further study.
ObjectiveTo systematically review the effectiveness and safety of laparoscopic operation versus laparotomy for stage I-IIa cervical cancer. MethodDatabases including PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI were searched to collect controlled trials and cohort studies about laparoscopic operation versus laparotomy for stage I-IIa cervical cancer from inception to July 2014. Two reviewers independently screened literature, extracted data, and evaluated the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 3 RCTs, 4 non-randomized controlled trials and 11 cohort studies involving 2 020 patients were included. The results of meta-analysis showed that, compared with laparotomy, laparoscopy operation could reduce intraoperative blood loss (MD=-247.99, 95%CI -408.90 to -87.07, P=0.003) , the incidence of perioperative blood transfusion (OR=0.33, 95%CI 0.21 to 0.52, P<0.000 01) , haemoglobin level before and after surgery (MD=-0.98, 95%CI -0.13 to -0.93, P<0.000 01) , postoperative complication (OR=0.61, 95%CI 0.40 to 0.93, P=0.02) , and shorten postoperative exhaust time (MD=-17.41, 95%CI -32.79 to -2.03, P=0.03) and postoperative hospitalization days (MD=-2.51, 95%CI -3.25 to -1.78, P<0.000 01) . There were no significant differences between two groups in the number of pelvic lymph nodes removed, operative complications, as well as the recurrence rate, mortality and non-recurrence survivals after 2 to 5 years of follow-up. But the operation time of the laparoscopy operation group was longer than that of the laparotomy group. ConclusionsCurrent evidence shows that compared with laparotomy, laparoscopic operation for early stage cervical cancer has less trauma, less blood loss, shorter hospitalization days and less postoperative complications. Due to the limited quantity of the included studies, more studies are needed to verify the above conclusion.
Objective To evaluate the diagnostic accuracy of human papillomavirus test for cervical neoplasia. Methods The Cochrane Library (Issue 2, 2010), Cochrane Central Register of Controlled Trials (Issue 2, 2010), and the following databases as CBMdisc, CNKI, MEDLINE, PubMed, and EMbase were all searched from their establishment to June 2010 to get all the randomized control trials (RCTs), and the relevant magazines and the references of the included studies were also searched. The screening, data extraction and quality assessment were conducted in accordance with the inclusion and exclusion criteria by two reviewers independently. The software Metadisc 1.4 was used to perform meta-analyses, and the forest plots and SROC curves were drewn with the RevMan 5.0 software. Results A total of 7 RCTs involving 171 604 subjects were included. The meta-analyses showed, the sensitivity of the HPV test for detecting cervical neoplasia (CIN) was higher than that of the conventional cytology test; the difference in sensitivity for detecting CIN in or above second grade was only found between the test of HPV combined with cervical cytology and the test of conventional cytology (Plt;0.00001), but the HPV test obviously lowered its diagnostic specificity. Among the following three tests for diagnosing CIN, such as, the single test of HPV, the combined test of HPV and cervical cytology, and the test of HPV followed by cytology shunting, the statistic differences compared with the conventional cytology test were found (Plt;0.01) except the last test (P=0.41) which had no difference in diagnosing CIN in or above the first grade. Conclusion The current evidence indicates that, compared with the conventional cytology test, the HPV combined with the cytology test can improve the sensitivity for diagnosing CIN in or above the second grade, but the HPV test cannot improve the specificity for cervical neoplasia. The application of human papillomavirus test for detecting cervical neoplasia needs to be further studied.
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。
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.