Objective To assess the efficacy and safety of laparoscopic staging and surgery for patients with cervical cancer. Methods We searched The Cochrane Library, MEDLINE, EMbase, CBM (from inception to 2009). Randomized controlled trials (RCTs) were identified according to the inclusion and exclusion criteria, and then the quality of included trials was accessed, and the data were extracted. Meta-analysis was performed by RevMan 5.0.2 software. Results Two RCTs involving 120 participants were included. The results of meta-analyses showed laparoscopic surgery, compared with open surgery, shortened postoperative ileus time (MD= –18.20, 95%CI –22.20 to –14.20, Plt;0.001), reduced the postoperative pain (MD= –1.30, 95%CI –1.86, to –0.74, Plt;0.001) and shortened the overall hospital stay (MD= –1.30, 95%CI –1.59 to –1.01, Plt;0.001). Currently, no evidence supported the superiority of laparoscopic surgery on duration of surgery, number of harvested lymph node and intraoperative blood loss over open surgery. Moreover, the laparoscopic surgery neither increased nor decreased the risk of postoperative complications. Conclusion The laparoscopic staging and surgery could shorten the recovery time of gastrointestinal function, shorten hospital stay, reduce pain in patients, but have no advantages in postoperative complications, operative time, number of lymph node biopsy, and intraoperative blood loss, compared with open surgery. However, the evidence is not b enough because of the low quality of the included studies. Thus, more high-quality RCTs are required in future.
【摘要】 目的 评价早期巨块型宫颈癌患者术前行新辅助化学疗法的近期疗效。 方法 回顾分析2005年10月-2010年6月收治的Ⅰb~Ⅱa期巨块型宫颈癌患者90例患者的临床资料。根据术前是否行化学疗法将患者分为两组；新辅助化学疗法（neoadjuvant chemotherapy，NACT）组50例，术前予静脉化学疗法或子宫动脉灌注化学疗法治疗1～3个疗程;直接手术组40例，直接行根治性手术。比较新辅助化学疗法前后病灶大小变化，化学疗法不良反应，手术情况及术后病理情况。 结果 NACT组总有效率86%（43/50），鳞癌疗效优于腺癌，动脉与静脉化学疗法近期有效率比较，两组差异无统计学意义（Pgt;0.05）。NACT不良反应小。NACT组术中出血少于直接手术组，两者差异有统计学意义（Plt;0.05）。两组深肌层浸润、淋巴结转移、脉管浸润差异均无统计学意义（Pgt;0.05），NACT组宫旁浸润率低于直接手术组。 结论 术前NACT对早期巨块型宫颈癌患者近期疗效显著。【Abstract】 Objective To evaluate the short-term curative effect of preoperative neoadjuvant chemotherapy on the early-stage bulky cervical carcinoma. Methods We retrospectively analyzed the clinical data of 70 patients with bulky ⅠB-ⅡA cervical carcinoma treated in our hospital between October 2005 and June 2010. Based on whether the patients received chemotherapy, they were divided into two groups: neoadjuvant chemotherapy group (NACT group) and direct surgery group. In the former group, there were 50 patients who underwent surgery after 1 to 3 cycles of preoperative chemotherapy by uterus artery infusion or intravenous chemoembolization. For the 40 patients in the latter group, direct radical surgery was performed. The size of the tumor before and after chemotherapy, the operation conditions and the postoperative pathological conditions of patients between the two groups were compared and the adverse reactions of neoadjuvant chemotherapy were analyzed as well. Results The total effective rate of NACT group was 86% (43/50). The response to chemotherapy in squamous cell caner was significantly higher than adenocarcinoma. There was no statistical difference between arterial and venous chemotherapy in terms of immediate effect (Pgt;0.05). The incidence of adverse reactions of neoadjuvant chemotherapy was low. There was significant difference between the NACT group and the direct surgery group in intraoperative bleeding (Plt;0.05). There were no significant differences between the above two groups in deep muscularis infiltration rate, lymph node metastasis rate and vascular invasion rate. However, the parametrial infiltration rate for the NACT group was lower than that for the direct surgery group. Conclusion Preoperative neoadjuvant chemotherapy on patients with early-stage bulky cervical carcinoma has a remarkable immediate curative effect.
【摘要】 目的 评价人乳头状瘤病毒(HPV)DNA检测在宫颈癌筛查中的价值。 方法 采用第二代杂交捕获(HCⅡ)技术和液基细胞学测试(LCT)2种方法,对1026例在妇科病中心就诊的受检者进行同步盲法检测,同时进行阴道镜检查。以宫颈活检组织病理学检查结果为诊断标准。评价该方案在宫颈癌筛查中的应用价值。 结果 病理检查结果显示,宫颈上皮内瘤变(CIN)Ⅰ级152例,CINⅡ级108例,CINⅢ级109例,宫颈浸润癌28例。筛查高危型HPV感染366例,阳性率3570%, 在不同宫颈病变中的阳性率分别是:宫颈癌9290%(26/28),CINⅢ900%(99/109),CINⅡ8890%(96/108),CINⅠ8750%(133/152)。高危HPV对宫颈高级别病变的敏感性、特异性、阳性预测值,阴性预测值分别是9860%、8610%、1480%和9980%;HPV与LCT联合检测(平行试验)的以上各指标分别是10000%、8090%、1210%和10000%。 结论 高危型人乳头状瘤病毒检测在宫颈癌前病变的筛查中有较高的敏感度和阴性预测值,联合LCT检测是目前宫颈癌筛查具有诊断价值的方法。【Abstract】 Objective To investigate the value of high risk human papillomavirus(HPV) DNA dectection for cervical cancer screening. Methods Hybrid capture Ⅱ(HCⅡ)human papillomavirus (HPV) test and liquid based cytology test (LCT) were performed in 1026 patients treaed in Xuzhou No.1 hospital from May 2008 to May 2009,and the abnomal cytological or HPV DNA findings were further biopsied under the colposcopeto to appraise the appicational importance of each approach for screening cervical cancer. Results Pathological results showed that cervical intraepithelial neoplasial(CIN)Ⅰin 152 patients,CIN Ⅱ in 108 patients,CIN Ⅲ 109 patients,invasive cervical cancer in 28 patients.HPV infected 366 patients in detection, with 3570% positive rate. The infection rate of HPV in cervical cancer was 929%(26/28),in CIN Ⅲ was 908%(99/109),in CIN Ⅱ was 889%(96/108),and in CIN Ⅰwas 875%(133/152).The pathological results treated as standard,the sensitivity, soecificiy, positive prevalue, negative prevalue of HCⅡ HPV for detecting highgrade cervical lesions were 986%,861%,148% and 998%.The values for HPVLCT parallel test were 1000%,809%,121% and 100%. Conclusion Highrisk HPV DNA test is of high sensitivity and negativepredictive value. The combination of HCⅡ HPV and LCT tests are of great value for screening cervical cancer at present.
ObjectiveTo investigate the clinicopathological features, diagnosis and differential diagnosis of villoglandular carcinoma of the uterine cervix. MethodsThe clinical data of a 34-year-old patient diagnosed with villoglandular carcinoma of cervix on April 6, 2010 was retrospectively analyzed. Surgical excision samples were analyzed by means of hematoxylin-eosin and immunohistochemical staining. ResultsThe gross appearance of the tumor mass showed cauliflower-like pattern of growth. Histologically, it was similar to colorectal villoglandular adenoma, and was composed of branching papillae shaped like villous glandular tube structure, and the surface was coated with pseudostratified or stratified columnar cells which showed mild atypia and uncommon mitotic figures. Immunohistochemically, tumor cells were positive for carcinoma embryonic antigen, CK7 and CA125, and negative for estrogen receptor, progesterone receptor, P16, p53 and vimentin. This patient was subjected to a follow-up of 48 months, and was alive without recurrence or metastasis. ConclusionsVilloglandular carcinoma of the uterine cervix is rare and has a favorable prognosis. The diagnosis of villoglandular carcinoma depends on pathological morphology, and meanwhile, it is necessary to distinguish villoglandular carcinoma from other benign and malignant tumors which exhibited papillary growth pattern.