Objective:To investigate the expression of pre-B-cell leukemia homeobox 3 (PBX3) and the phosphatase and tensin homology deleted on chromosome 10 (PTEN) in cervical cancer and its relationship with the clinicopathologic characteristics and prognosis.Methods:Cervical cancer tissues and adjacent tissues of 85 patients with cervical cancer admitted to Xianlin Gulou Hospital from June 2014 to December 2018 were collected and the expression levels of PBX3 and PTEN were detected by immunohistochemistry. The univariate analysis and Logistic regression model were used to analyze the relationship between the expression levels of PBX3, PTEN and clinicopathologic features. Kaplan-Meier survival curve was used to analyze the relationship between the expression levels of PBX3, PTEN and prognosis.Results:The positive expression rate of PBX3 protein in cervical cancer tissues was higher than that in adjacent tissues: 38.82%(33/85) vs. 25.53%(20/85); the positive expression rate of PTEN protein was lower than that in adjacent tissues: 36.47%(31/85) vs. 98.82%(84/85), and there were significant differences ( P<0.05). The univariate analysis showed that the expression levels of PBX3 and PTEN were associated with clinical stages, degree of tumor differentiation, lymph node metastasis, vascular invasion, and degree of tumor invasion ( P<0.05). The multiple Logistic regression model showed that the clinical stages, tumor differentiation and lymph node metastasis were independent influencing factors for the positive expression of PBX3 or PTEN in cervical cancer tissues ( P<0.05). While 45.45%(15/33) of patients with positive PBX3 expression died, with a median survival of 31 months, and 25.00% (13/52)of patients with negative expression died, with a median survival of 38 months. Kaplan-rank test showed that the survival time in the patients with positive PBX3 expression and in the patients with negative expression had significant difference ( P=0.025). While 22.58%(7/31) of patients with positive PTEN expression died, with a median survival of 39 months, and 38.89%(21/54) of the patients with negative expression died, with a median survival time of 33 months. Kaplan-rank test showed that the survival time in the patients with positive PTEN expression and in the patients with negative expression had significant difference ( P=0.035). Conclusions:The expression of PBX3 is up-regulated and PTEN is down-regulated in cervical cancer. The expression levels of PBX3 and PTEN are related to clinical stage, tumor differentiation and lymph node metastasis. The prognosis of the patients with positive PBX3 expression is worse than that of the patients with negative expression, and the prognosis of the patients with positive PTEN expression is better than that of the patients with negative expression.

目的 研究桂枝茯苓丸对慢性盆腔炎大鼠炎症反应影响及子宫组织半胱氨酸蛋白酶-3(caspase-3)、半胱氨酸蛋白酶-8 (caspase-8)表达的影响.方法 通过混合菌液加机械损伤法建立慢性盆腔炎模型.桂枝茯苓丸高、中、低剂量组分别给予含生药18、9、4.5 g/kg的桂枝茯苓丸灌胃,左氧氟沙星组给予30 mg/kg左氧氟沙星灌胃,假手术组和模型组均灌胃等体积的生理盐水,每日1次,连续给药21 d.结果 给药后左氧氟沙星组,桂枝茯苓丸高、中、低剂量组大鼠血清白介素1β(IL-1β)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平均低于给药前,模型组均高于假手术组;假手术组子宫内膜无充血,上皮组织结构清晰完整,上皮细胞排列整齐;模型组可见大量炎性细胞浸润,子宫内膜扩张充血,纤维结缔组织增生严重;左氧氟沙星组与桂枝茯苓丸高、中、低剂量组和模型组比较炎性细胞浸润减少,子宫内膜充血减轻,纤维组织减少;子宫组织细胞凋亡率,caspase-3、caspase-8 mRNA和蛋白以及cleaved caspase-3、cleaved caspase-8蛋白表达表现为模型组均高于假手术组(P＜0.01),左氧氟沙星组和桂枝茯苓丸高、中、低剂量组均高于模型组(P＜0.01).结论 桂枝茯苓丸可治疗慢性盆腔炎大鼠,其机制可能与上调caspase-3、caspase-8表达,提高cleaved caspase-3、cleaved caspase-8表达有关.

目的 探讨Wnt通路对多囊卵巢大鼠子宫内膜降钙素表达的影响.方法 健康雌性SD大鼠54只随机分为3组:空白组、模型组与Wnt组,每组6只大鼠.Wnt组建立多囊卵巢综合征模型,模型建立后21 d,Wnt组静脉注射阿西替尼30 mg/kg,每3天1次,连续应用7次.模型组也构建多囊卵巢综合征模型,建模后采用PBS注射处理.空白组不建立多囊卵巢综合征模型.记录所有大鼠的血清雌二醇(E2)表达、降钙素表达、肌酸激酶同工酶(CK-MB)和乳酸脱氢酶(LDH)活性等情况.结果 模型组与Wnt组大鼠给药第1次、第3次与第7次的血清E2水平显著低于空白组(P＜0.05),Wnt组高于模型组(P＜0.05),不同组别的血清FHS与LH水平对比差异无统计学意义(P＞0.05).模型组与Wnt组大鼠给药第1次、第3次与第7次的血清CK-MB和LDH活性都显著高于空白组(P＜0.05),Wnt组显著低于模型组(P＜0.05).模型组与Wnt组大鼠给药第1次、第3次与第7次的子宫内膜降钙素含量显著低于空白组(P＜0.05),Wnt组高于模型组(P＜0.05).结论 抑制Wnt通路能够抑制多囊卵巢大鼠子宫内膜降钙素表达,从而促使性激素分泌正常,降低CK-MB和LDH活性,改善多囊卵巢综合征症状.

Objective To investigate the risk factors of the recurrence of stage Ⅰ-Ⅱ endometrial carcinoma. Methods We retrospectively analyzed the data of 516 patients with stage Ⅰ-Ⅱ endometrial carcinoma treated in Nanjing Drum Tower Hospital from January 2010 to December 2017. The recurrence rate of the patients was followed up. Results The recurrence rate was 8.91%(46/516). Age, body weight, hypertension, stage of operation and pathology, pathological type, low expression of ER and PR were correlated with the recurrence of stage Ⅰ-Ⅱ endometrial carcinoma (P < 0.05). Diabetes mellitus, vascular metastasis, pathological differentiation, lymph node excision and ascites cytologic examination were not correlated with the recurrence of stage Ⅰ-Ⅱ endometrial carcinoma (P > 0.05). Age, body weight and blood pressure were independent risk factors for the recurrence of stageⅠ-Ⅱendometrial carcinoma (P < 0.05). Conclusion Age, body weight, hypertension, stage of operation and pathology, pathological type, low expression of ER and PR affect the recurrence of stage Ⅰ-Ⅱ endometrial carcinoma. Advanced age, low body weight and hypertension are independent risk factors for the recurrence of stage Ⅰ-Ⅱ endometrial carcinoma. In clinical work, we should follow up closely stage Ⅰ-Ⅱ endometrial carcinoma patients with advanced age, low body weight and hypertension, for early detection and in-time treatment of recurrence lesions.

目的 探讨雌二醇(E2)联合孕激素(P4)对microRNA-15a(miR-15a)表达的影响.方法 采集手术中切除的卵巢癌组织标本进行细胞培养,分3个处理组:E2组,P4组和雌二醇联合孕激素(E2+P4)组.激素处理后,MTT法检测细胞存活率;流式细胞技术检测细胞凋亡与细胞周期;qRT-PCR法检测Bcl-2,Bax和miR-15a的相对表达量.结果 高浓度(浓度均为10-4 mol·L-1)的E2,P4,E2+P4能够降低卵巢癌细胞的存活率,并表现为时间依赖性;低浓度(≤10-8 mol·L-1)E2能够提高卵巢癌细胞的存活率.与对照组相比,高浓度E2,P4和E2+P4能够增加卵巢癌细胞的凋亡率(P＜0.001),并且E2+P4的作用最明显;低浓度E2能够抑制肿瘤细胞的凋亡(P＜0.001).E2,P4和E2+P4对细胞周期的影响没有统计学差异.高浓度的E2,P4和E2+P4能够下调Bcl-2的表达(P＜0.05或P＜0.001),上调Bax的表达(P＜0.001);但是低浓度E2作用却相反.高浓度的E2+P4能够促进miR-15a的表达(P＜0.001).结论 高浓度的E2,P4和E2+P4能够降低细胞的存活率促进细胞凋亡,下调Bcl-2的表达,上调Bax的表达;低浓度E2的作用则相反;高浓度的E2+P4能够促进miR-15a的表达.

目的 探讨女性生殖系统恶性中胚叶混合瘤(malignant mixed mesodermal tumors,MMMTs)的临床特点、诊治难点及预后.方法 回顾性分析2010年6月年至2017年6月南京大学医学院附属鼓楼医院妇科收治的经病理确诊的22例生殖系统MMMTs患者的临床资料.结果 22例患者中,子宫体MMMTS15例,输卵管卵巢MMMTs 6例,宫颈MMMTs 1例.子宫体MMMTs主要表现为异常阴道出血、排液;输卵管卵巢MMMTs主要表现为腹痛、盆腔包块;53.3％(8/15)的子宫体MMMTs在相对早期诊治,但首次病理诊断的准确率仅31.8％(7/22),95.5％(21/22)的患者分别接受了1～2次肿瘤切除手术.其中临床病理分期Ⅰ期患者10例,中位生存时间为33个月;Ⅲ期患者10例,中位生存时间为14个月;Ⅳ期患者1例,术后11个月复发,术后22个月死亡.结论 恶性中胚叶混合瘤多发于围绝经期和绝经后妇女,恶性程度高,死亡率高,需制定个体化的综合治疗方案.

目的 研究淋巴血管间隙浸润(LVSI)的子宫内膜癌的临床病理特征,以及与预后的相关性.方法 回顾性分析2007年1月～2017年12月在南京鼓楼医院治疗的671例子宫内膜癌患者的病例资料,其中LVSI阳性组120例,LVSI阴性组551例;分析患者的临床病理信息,建立Kaplan-Meier曲线,并进行单因素和多因素分析.结果 与LVSI阴性组比较,LVSI阳性组已绝经、手术病理期别晚、深肌层浸润、组织分化差、伴淋巴结转移、发生复发及死亡患者占比升高,差异有统计学意义(P＜0.05);两组有内科合并症(高血压、糖尿病)或子宫肌瘤患者占比比较,差异无统计学意义(P＞0.05).多因素分析结果显示,宫颈间质累及(OR=0.342,95％CI:0.134～0.873,P＜ 0.05)、LVSI(OR=0.110,95％CI:0.051～0.238,P＜0.01)与淋巴结转移显著相关;生存率分析结果表明,在LVSI阳性的患者中,总生存率和无复发生存率均显著降低(P＜ 0.05);COX回归结果显示,手术期别晚、非内膜样癌、LVSI影响子宫内膜癌患者的生存时间及结局(P＜0.05).结论 LVSI与淋巴结转移密切相关,可作为预测淋巴结转移的重要因素;LVSI是子宫内膜癌不良预后的重要危险因素.

目的:探讨化疗联合孕激素治疗子宫内膜癌分期手术后患者的近远期疗效.方法:收集我院2010年1月至2015年12月收治的102例子宫内膜癌患者,根据治疗方法分为对照组(52例,给予分期手术+化疗治疗)与研究组(50例,给予分期手术+化疗+孕激素治疗),两组均连续治疗12周,比较两组患者临床治疗总有效率、局部复发率、远处转移率、3年生存率、生活质量评分及并发症的发生情况.结果:治疗后,研究组和对照组治疗总有效率分别为82.00％、63.46％,研究组显著高于对照组(P＜0.05);研究组的局部复发率为4.00％,远处转移率为2.00％,3年生存率为90.00％,均明显低于对照组(15.38％、11.54％、73.08％,P＜0.05);研究组的心理功能、躯体功能、社会功能、物质生活评分均高于对照组(P＜0.05);髓抑制、胃肠道反应、白细胞下降、肾损伤、血小板减少发生率明显低于对照组(P＜0.05).结论:分期手术联合化疗、孕激素治疗子宫内膜癌患者有较好的近远期疗效,可有效改善患者预后,提高其生活质量.

目的 :观察左旋甲状腺素早期干预对亚临床甲状腺功能减退症(Subclinical hypothyroidism,SCH)孕妇妊娠结局的影响,探讨其临床应用价值.方法 :对174例SCH孕妇(SCH组)及同期50名甲状腺功能正常孕妇(对照组)开展前瞻性对照分析.将SCH组孕妇随机分为治疗组、非治疗组各87例.治疗组孕妇接受左旋甲状腺素早期干预并持续至分娩.检测各组孕妇孕早期甲状腺功能,对比三组孕妇妊娠并发症及不良结局发生情况,总结SCH对孕妇妊娠结局的影响以及左旋甲状腺素的早期干预效果.结果 :治疗组、非治疗组入组时TSH高于对照组,差异有统计学意义(P<0.05),三组孕妇FT3、FT4比较,差异无统计学意义(P>0.05).非治疗组自发性流产、妊娠期糖尿病、妊娠期高血压发生率均高于治疗组、对照组,差异有统计学意义(P<0.05);治疗组与对照组妊娠并发症发生情况比较,差异无统计学意义(P>0.05).三组孕妇妊娠结局比较,差异无统计学意义(P>0.05).结论 :孕早期SCH并不会对孕妇妊娠结局造成明显影响,但左旋甲状腺素早期干预可降低孕妇妊娠期并发症发生率,也应纳入抗甲状腺过氧化物酶抗体(TPOAb)阴性SCH孕妇的妊娠期干预策略.

Background Heterotopic interstitial pregnancy is a rare variant of heterotopic pregnancies, and it poses challenges in treating the heterotopic pregnancy and preserving the intrauterine pregnancy. However, there is no clear consensus regarding the optimal management. The aim of this study was to investigate the pregnancy outcomes of women diagnosed with heterotopic interstitial pregnancy. Methods A total of 17 women diagnosed with heterotopic interstitial pregnancy between July 2010 and December 2015 were included. General characteristics of each patient, including age, gravidity and parity, history of pelvic inflammatory disease or surgery, and especially the corresponding therapeutic interventions, were retrospectively analyzed. Moreover, pregnancy outcomes were further followed by face-to-face interview. Results Of the 17 patients, 10 (58.5%) underwent surgical treatment (7 laparoscopic cornual resection, and 3 laparotomy); and 3 cases simultaneously terminated the intrauterine pregnancy by suction evacuation. Compared with laparotomy, laparoscopic cornual section showed shorter operative time (median 40 vs. 70 min), less blood loss (150 vs. 400 ml) and shorter hospital stay (2 vs. 4 days). In addition, 4 (23.5%) patients underwent selective embryo reduction under transvaginal ultrasound guidance. Expectant management was chosen in the remaining 3 patients. In the follow-up study, other than a case of missed miscarriage, the other 13 women who remained committed to their pregnancies all delivered healthy babies either by caesarean section or vaginal birth. No congenital anomalies were reported, and all the infants were in good growth and development. Conclusions Laparoscopic cornual resection is a feasible approach with favorable surgical and long-term pregnancy outcomes. Additionally, medical or expectant management may be a viable treatment option for selected symptom-free patient. Although the survival of the intrauterine pregnancy could not always be assured, the prognosis for a woman with heterotopic interstitial pregnancy is generally good.

目的 分析研究一次性宫颈球囊扩张器在妊娠晚期引产中的应用效果.方法 选取2017年1月～2018年1月,我院接收的54例妊娠晚期引产孕妇,随机分为对照组27例和观察组27例,观察组孕妇进行一次性球囊宫颈扩张器联合缩宫素引产,对照组使用缩宫素引产,比较两组孕妇的宫颈成熟情况、阴道分娩率、临产时间、总产程、孕妇满意度.结果 两组孕妇的宫颈成熟情况引产后,观察组评分明显高于对照组;观察组孕妇阴道分娩率为88.89％,对照组孕妇阴道分娩率为62.96％,观察组明显高于对照组;观察组经阴道分娩的孕妇临产时间和总产程与对照组相比均比对照组高;观察组孕妇满意度为92.59％,对照组孕妇满意度为81.48％,对照组低于观察组,对比差异,P<0.05,统计学无意义.结论 一次性宫颈球囊扩张器在妊娠晚期引产中的效果显著,可以提高自然分娩率,降低剖宫产的情况,值得临床推广应用.

目的:探究子宫内膜癌组织中微小RNA106b(miR-106b)与残疾基因同源物(DAB2)表达水平与临床病理特征及患者预后的关系.方法:收集2010年5月-2015年2月本院手术切除的子宫内膜癌临床资料70例(观察组),同期本院子宫内膜癌切除手术的癌旁组织标本70例(止常组).qRT-PCR检测子宫内膜组织中miR-106b、DAB2表达,免疫组化法检测子宫内膜组织中DAB2蛋白表达.根据miR-106b表达量分为高表达组与低表达组,观察分析miR-106b、DAB2表达与临床病理特征关系.Pearson法进行相关性分析,采用Kaplan-Meier对患者的生存情况进行分析,采用cox分析进行多因素分析.结果:观察组子宫内膜癌组织中miR-106b表达水平高于正常组,DAB2表达水平低于正常组,免疫组化结果显示观察组中DAB2蛋白阳性表达率低于正常组(均P＜0.05);临床病理结果显示,miR-106b、DAB2表达均与FIGO分期、P53及Ki67显著相关,相关性分析miR-106b与DAB2表达呈负相关,Kaplan-Meier分析结果显示miR-106b低表达组与DAB2阳性表达组PFS均高于高表达组、阴性表达组(P＜0.05);Cox多元回归分析结果显示miR-106b、DAB2表达均是患者预后的危险因素.结论:miR-106b在子宫内膜癌组织中上调表达、DAB2下调表达,二者呈负相关且均与肿瘤组织分化及细胞增殖迁移有关,可作为临床早期诊断治疗子宫内膜癌及有效评估患者预后的指标.

目的:探讨妊娠期高血压患者血清可溶性凝集素样氧化型低密度脂蛋白受体-1(sLOX-1)与人绒毛膜促性腺激素(β-hCG)及妊娠结局的相关性.方法:收集本院收治的妊娠期高血压患者68例(观察组),选取同期正常产检的健康孕妇68例(对照组),采用酶联免疫吸附法(ELISA)检测sLOX-1浓度,化学发光分析法检测血清β-hCG水平,比较并分析sLOX-1、β-hCG水平与不良妊娠结局的关系.结果:观察组血清sLOX-1、β-hCG水平高于对照组,且观察组中重度＞中度＞轻度(均P＜0.05);Pearson相关性分析显示,观察组血清sLOX-1与β-hCG水平呈明显正相关(r=0.742,P=0.000);观察组血清sLOX-1水平与妊娠高血压疾病、早产、胎儿窘迫、胎膜早破、胎儿生长受限呈正相关,β-hCG水平与妊娠期高血压疾病、胎儿窘迫、胎儿生长受限呈正相关(均P＜0.05),与早产、胎膜早破无明显相关性(P＞0.05).结论:妊娠期高血压孕妇血清sLOX-1、β-hCG水平升高,并与不良妊娠结局相关,临床中可通过血清sLOX-1、β-hCG水平检测辅助预测不良妊娠结局发生.

目的 探讨早孕期剖宫产术后子宫瘢痕妊娠(CSP)各临床分型的手术治疗效果.方法 选择2013年1月至2018年2月确诊为CSP的患者183例为观察对象,并将其分为Ⅰ型组55例、Ⅱ型组77例、Ⅲ型组26例、包块型组25例.对各分型中行腹腔镜或B超监视下清宫术、腹腔镜或B超监视下清宫术+水囊填塞术、腹腔镜下清除胚胎联合清宫术+子宫瘢痕切除修补术及子宫动脉介入栓塞术后清宫术4种手术方式的治疗效果进行分析,比较各手术治疗CSP的手术时间、术中出血量、住院时间、术后阴道流血时间、术后月经来潮时间以及术后血β-HCG降至正常时间.结果 腹腔镜或B超监视下清宫术、腹腔镜或B超监视下清宫术+水囊填塞治疗Ⅰ型、Ⅱ型、Ⅲ型及包块型CSP的术中出血量呈上升趋势;而腹腔镜下清除胚胎联合清宫术+子宫瘢痕切除修补术及子宫动脉介入栓塞术后清宫术治疗各型CSP的术中出血量无明显差异.上述4种手术方式在治疗Ⅰ型、Ⅱ型CSP的手术时间、住院时间、术后阴道流血时间、术后月经来潮时间以及术后血β-HCG降至正常时间比较差异无统计学意义(P>0.05);而腹腔镜下清除胚胎联合清宫术+子宫瘢痕切除修补术治疗Ⅲ型、包块型CSP患者,术后阴道流血时间、术后月经来潮时间、术后血β-HCG降至正常时间均短于上述其他3种手术方法(P<0.05).结论 孕早期CSP的手术治疗方案可根据临床分型选择合理的有效治疗措施,腹腔镜或B超监视下清宫术适用于Ⅰ型、Ⅱ型CSP患者;腹腔镜下清除胚胎联合清宫术+子宫瘢痕切除修补术更适用于Ⅲ型、包块型CSP患者.

Objective:To investigate the correlation of serum concentration of vascular endothelial growth factor (VEGF),insulin-like growth factor 1 (IGF 1) and CA125 with uterine artery embolization (UAE) in the treatment of uterine adenomyosis.Methods:39 cases of uterine adenomyosis patients were chosen as patient group and received uterine artery embolization,30 healthy subjects were selected as control.The serum concentrations ofVEGF,IGF 1,CA125 before and after the operation were quantified by ELISA at different time points.The curative effect after uterine artery embolization was evaluated.Results:After 1 month of UAE,in 34 patients with dysmenorrhea,29 cases turned to be complete remission with its final efficiency of 85.2％.The VEGF,IGF 1 and CA125 concentrations in serum of patient group were significantly higher than those of normal control group before UAE treatment (P＜0.05).After uterine artery embolization,the serum concentrations of IGF 1,VEGF and CA125 of patient group decreased significantly.After 6 months of UAE treatment,all indicators turned to be at normal level.Conclusion:The changes of serum IGF-1,VEGF and CA125 concentrations could be taken as curative effect and prognosis marker of uterine artery embolization in the treatment of uterine adenomyosis.

From January 2015 to October 2015 in our hospital outpatient follow-up at gestational age of 5 to 6 weeks of missed abortion,threatened abortion and normal pregnancy were 50 cases,compared 3 groups of pregnant women serum progesterone and estradiol,human chorionic gonadotropin (HCG)clinical test results.The missed abortion group,estradiol,progesterone and HCG levels were significantly lower than those in normal pregnancy group and threatened abortion group (P ＜ 0.05),missed abortion group HCG doubled after 48 hours was significantly lower than that in normal pregnancy group and threatened abortion group,and was statistically significant (P ＜ 0.05),to 1 weeks after the HCG changed little,and missed abortion group of estradiol and progesterone levels during pregnancy with growth gradually decreased,and pregnant women of normal pregnancy and threatened abortion group gap is gradually increased.The dynamic changes of joint monitoring of serum progesterone (P) and estradiol and human chorionic gonadotropin (HCG) can make an accurate prediction of pregnancy outcome in early pregnancy timely,and improve the early detection rate of missed abortion,which can be used for early detection of adverse pregnancy,and guide clinical treatment and avoid blind miscarriage.

目的:探讨对进行卵巢移位术后的宫颈癌患者实施插入式后装放疗联合盆腔外放疗的临床效果.方法:将在我院接受卵巢移位术后进行放疗的58例宫颈癌患者作为本次研究的对象.按照术后放疗方法的不同,将这58例患者分为甲组(23例)和乙组(35例).在其接受卵巢移位术后,我院对甲组患者进行盆腔外放疗,对乙组患者联合进行插入式后装放疗与盆腔外放疗,然后比较两组患者血清卵泡刺激素(FSH)的水平、血清雌二醇(E2)的水平、Kupperman评分及其术后并发症的发生率.结果:经放疗,乙组患者E2的水平明显高于甲组患者,其FSH的水平明显低于甲组患者,其Kupperman评分明显低于甲组患者,其放疗并发症的发生率明显低于甲组患者,差异有统计学意义(P<0.05).结论:对进行卵巢移位术后的宫颈癌患者联合实行插入式后装放疗与盆腔外放疗的临床效果显著,能有效地改善其E2和FSH的水平,降低其放疗并发症的发生率.

Objective:To evaluate the efficacy and security of preoperative brachyther-apy combinded concurrent chemotherapy ( preoperative brachy-chemothepapy ) in the compre-hensive treatment for patients with FIGO stage ⅠB2 andⅡA2 cervical cancer. Methods:Total of 82 patients with FIGO stage ⅠB2 andⅡA2 cervical cancer were enrolled retrospectively treated in the department of Gynaecology of Drum Tower Hospital affiliated to Medical College of Nanjing University from June 2010 to May 2015 . According to the different preoperative regi-mens,they were categorized into three groups,including directly surgical group ( Group A,27 cases) ,neoadjuvant chemotherapy group ( Group B,41 cases) ,and brachy-chemotherapy group ( Group C,14 cases) . Radical hysterectomy was performed following the later two regimens. To compare three groups of postoperative hospital stay, average intraoperative blood loss, average surgical time,clinical pathological remission rate,incidence of complications and recent survive time. Results:Postoperative hospital stay was significantly more in group B than group A. Intra-operative blood loss was significantly more in group B than in group C. These difference were statistically significant (P<0. 05). Vascular invasion rate,deep muscle invasion rate and lymph node positive rate in group C were lower than in group A and B. All these difference were statis-tically significant (P<0. 05),and no statistically significant difference were noted in latter two groups (P>0. 05),and three groups had no significant difference in nerve invasion rate (P>0. 05 ) . The preoperative therapeutic effective rate of 85 . 7% in group C was much higher than 36 . 4% in group B with a statistically significant difference ( P<0 . 05 ) . The occurrence rate of sur-gery-related complications and nerve invasion rate had no statistically significant difference a-mong three groups. Median survival time and 3-year survival rate in group A,B and C were 41. 2 months(95%CI:33. 8 ~48. 5 months) and 63. 9%,33. 8 months(95%CI:28. 9 ~38. 7 months)and 53. 1%,48. 1 months(95%CI:37. 5 ~58. 7 months)and 68. 2% respectively, where there were no statistically significant difference among three groups ( P>0 . 05 ) . Lymph node metastasis was a independent risk factor of decreasing survival time ( P<0 . 05 ) . Conclu-sions:For no-significantly increasing the occurrence rate of surgery-related complications,surgi-cal time,intraoperative blood loss,preoperative brachytherapy combinded concurrent chemother-apy is a safe and effective regimen for patients with stage ⅠB2 andⅡA2 cervical cancer.

目的 探讨同步放化疗中晚期宫颈癌患者预后的影响因素.方法 回顾性调查南京大学医学院附属鼓楼医院2005-2010年采用单纯同步放化疗治疗的125例宫颈癌患者的临床资料,分析同步放化疗中晚期宫颈癌患者预后的影响因素.结果 125例平均年龄(46.48±10.86)岁,其中Ⅱb期55例、Ⅲ期47例、Ⅳ期23例;鳞癌110例,腺癌15例.患者3年及5年生存率分别为72.00％和61.60％.单因素分析结果显示生存率与年龄、分化程度、FIGO分期、肿瘤直径及血红蛋白量显著相关(P＜0.05),并且5年生存率与肿瘤组织类型显著相关(P＜0.05).多因素分析显示,分化程度及FIGO分期(P=0.00)是影响患者3年及5年生存率的独立因素.125例中77例(61.60％)出现放射性肠炎,8例(6.40％)出现放射性膀胱炎,6例(4.80％)出现下肢淋巴结水肿,114例(91.20％)出现不同程度的骨髓抑制症状,125例(100％)出现外阴炎表现,119例(95.2％)出现不同程度消化道症状.单因素分析显示,同步放化疗并发症的发生与年龄、肿瘤的组织类型、分化程度、FIGO分期及血红蛋白量均无显著相关性.结论 中晚期宫颈癌同步放化疗的预后与患者肿瘤的分化程度、分期有相关性.

目的：：比较3种不同的人工阴道成形术术后患者性生活质量差异，指导临床治疗中术式的选择。方法：收集1998年6月至2010年9月于南京大学医学院附属鼓楼医院及东南大学附属中大医院实施人工阴道成形术的患者36例，按不同术式分为3组：乙状结肠代阴道成形组11例、腹膜代阴道成形组12例(其中 1例为羊膜代阴道成形术)和阴股沟皮瓣代阴道成形组13例。采用电话问卷调查的方式根据女性性功能指标量表(FSFI)中的内容量化患者近期的性功能情况，评价、对比上述3种不同术式术后患者的性生活质量。结果：阴道润滑指标和性满意度指标得分由高到低依次为腹膜代阴道成形术组、乙状结肠代阴道成形术组和阴股沟皮瓣代阴道成形术组。腹膜代阴道成形术组、乙状结肠代阴道成形术组的阴道润滑指标得分均高于阴股沟皮瓣代阴道成形术组，差异有统计学意义(P<0.05)；前两组比较差异则无统计学意义(P>0.05)。腹膜代阴道成形术组的性高潮指标得分高于乙状结肠代阴道成形术组和阴股沟皮瓣代阴道成形术组，差异有统计学意义(P<0.05)；后两组比较差异则无统计学意义(P>0.05)。乙状结肠代阴道成形术组的性满意度指标得分与腹膜代阴道成形术组和阴股沟皮瓣代阴道成形术组比较，差异无统计学意义(P>0.05)；腹膜代阴道成形术组高于阴股沟皮瓣代阴道成形术组，差异有统计学意义(P<0.05)。3组的性欲望、性唤起及性交痛指标两两比较，差异均无统计学意义(P>0.05)。3组间的 FSFI 总分情况与阴道润滑指标情况相同。结论：术后患者的性生活质量在总体上是腹膜代阴道成形术组优于乙状结肠代阴道成形术组优于阴股沟皮瓣代阴道成形术组。