子宫肌瘤及子宫腺肌病动脉栓塞治疗手术质量涉及术前诊断、临床症状评估、手术适应证和禁忌证掌控、手术操作过程技巧、术后疗效评估、并发症管理、术后随访等诸多环节,各个环节需要有明确的质量控制标准且能符合普遍适用原则,由此,才可能建立动脉栓塞治疗标准临床路径的精细化管理制度.

目的 从肿瘤学结局角度对比FIGO 2018子宫颈癌新分期Ⅰ B3期开腹广泛性子宫切除手术(ARH)、新辅助化疗后开腹手术(NACT)、根治性放化疗(R-CT)3种治疗方式的差异,探讨Ⅰ B3期子宫颈癌适宜治疗策略.方法 基于中国子宫颈癌临床诊疗项目数据库,纳入FIGO 2018子宫颈癌Ⅰ B3期病例,在真实世界研究比较ARH组、NACT组及R-CT组的5年总体生存率(OS)及无病生存率(DFS).结果 (1)从数据库中纳入FIGO 2018子宫颈癌Ⅰ B3期病例1434例,其中ARH组830例、NACT组484例、R-CT组120例.中位随访时间为46个月(ARH组55个月、NACT组44个月、R-CT组32个月).(2)NACT组、ARH组及R-CT组之间5年OS差异有统计学意义(97.0％ vs.91.1％ vs.78.1％,P＜0.001),5年DFS差异有统计学意义(92.3％ vs.87.4％ vs.71.1％,P＜0.001).(3)Cox回归分析提示NACT组发生死亡的风险是ARH组的0.352倍(HR=0.352,95％CI 0.189～0.654,P=0.001),不是复发/死亡的独立影响因素(HR=0.592,95％CI 0.391～0.898,P=0.202);R-CT组发生死亡的风险是ARH组的2.997倍(HR=2.997,95％CI 1.754～ 5.121,P＜0.001),R-CT组发生复发/死亡的风险是ARH组的2.832倍(HR=2.832,95％CI 1.803～4.449,P＜0.001).结论 比较3种治疗方式的肿瘤学结局,FIGO 2018子宫颈癌Ⅰ B3期接受新辅助化疗后开腹手术的肿瘤学结局最佳,接受开腹广泛性子宫切除手术次之,接受根治性放化疗较差.因此,Ⅰ B3期的合适治疗方式可能是新辅助化疗后手术.

目的 探讨在真实世界研究条件下的Ⅰ A1 (LVSI+)～ⅡA2期子宫颈癌腹腔镜与开腹手术的长期肿瘤学结局.方法 基于中国子宫颈癌临床诊疗大数据库,在真实世界研究及1:1倾向评分匹配条件下,比较匹配前后ⅠA1(LVSI+)～ⅡA2期子宫颈癌腹腔镜与开腹手术5年总体生存率(OS)及无病生存率(DFS).结果 (1)将中国子宫颈癌临床诊疗大数据库中2009年1月1日至2016年12月31日全部的Ⅰ A1 (LVSI+)～ⅡA2期15 515例子宫颈癌腹腔镜及开腹手术病例纳入研究中,腹腔镜组5205例,开腹组10 310例,两组患者5年OS无差异,5年DFS腹腔镜组低于开腹组(OS:88.7％ vs.90.3％,P--0.678,DFS:84.3％ vs.86.4％,P=0.006),Cox多因素分析提示腹腔镜手术是患者死亡和复发/死亡的独立危险因素(OS:HR=1.233,95％CI 1.073～1.417,P=0.003;DFS:HR=1.314,95％CI1.184～1.458,P＜0.001);但两组患者在年龄、组织学类型、分期及术后病理中高危因素等存在差异,再行1:1匹配后发现腹腔镜组(4317例)与开腹组(4317例)5年OS及DFS腹腔镜组均低于开腹组(OS:89.3％ vs.92.6％,P=0.009,DFS:84.8％ vs.89.1％,P＜0.001),且腹腔镜手术是影响患者死亡和复发/死亡的独立危险因素(OS:HR=1.341,95％CI 1.114～1.616,P--0.002;DFS:HR=1.454,95％CI 1.265～1.670,P＜ 0.001).(2)进一步限定子宫切除类型为QM-B型/C型进行分析,腹腔镜组5019例,开腹组9473例,两组患者5年OS无差异,5年DFS腹腔镜组低于开腹组(OS:89.0％ vs.90.5％,P=0.630,DFS:84.3％ vs.86.6％,P=0.005),Cox多因素分析提示腹腔镜手术是影响患者死亡与复发/死亡的危险因素(OS:HR=1.229,95％CI 1.065～1.418,P=0.005;DFS:HR=1.324,95％CI 1.190～1.474,P=0.005);行1:1匹配后腹腔镜组(4210例)与开腹组(4210例)5年OS及DFS比较:腹腔镜组均低于开腹组(0S:89.5％ vs.92.1％,P=0.014,DFS:84.2％ vs.88.2％,P＜0.001),Cox多因素分析提示腹腔镜手术是影响患者死亡与复发/死亡的独立危险因素(OS:HR=1.330,95％CI 1.109～1.595,P=0.002;DFS:HR=1.404,95％CI 1.226～1.607,P＜0.001).结论 在真实世界研究条件下,Ⅰ A1(LVSI+)～ⅡA2期子宫颈癌腹腔镜组5年OS及DFS均低于开腹组,且腹腔镜手术是影响患者死亡及复发/死亡的独立危险因素.

目的 探讨2004-2015年国内开展腹腔镜手术治疗子宫颈癌的情况并分析其相关因素.方法 采取多中心回顾性研究方法,收集2004-2015年,国内共计37家医院(南方医科大学南方医院、安徽省肿瘤医院、中日友好医院等)妇科手术治疗的子宫颈癌患者,分析其12年间腹腔镜手术治疗子宫颈癌的整体情况.根据入组标准共纳入24 757例,其中开腹手术18 701例为对照组,腹腔镜手术6056例为观察组,收集相关临床资料,分析腹腔镜手术占比的变化趋势及两组资料的差异.结果 12年间,国内37家医院子宫颈癌总手术量增长7.31倍,年增长率为19.82％;子宫颈癌腹腔镜手术量增长252倍,年增长率为65.31％;相关因素分析发现患者年龄、FIGO分期、病灶大小、子宫切除类型和就诊医院类型是手术方式选择的影响因素(P＜0.05).结论 近12年来,国内子宫颈癌腹腔镜手术开展迅速,医生更倾向于选择早期、病灶小、年轻的患者实施该术式.

目的 应用大数据探讨中国ⅠB2期子宫颈癌患者腹腔镜与开腹手术的长期肿瘤学结局差异.方法 基于中国子宫颈癌临床诊疗大数据库,回顾性分析2009-2016年国内部分地区Ⅰ B2期子宫颈癌腹腔镜与开腹手术病例,通过真实世界研究(RWS)和倾向评分匹配(PSM)的方法,分析2种手术途径5年总体生存率(OS)和无病生存率(DFS)的差异.结果 (1)初始入组共纳入2176例病例,其中腹腔镜组646例,开腹组1530例.匹配前两组5年OS差异无统计学意义(82.5％ vs.88.4％,P=0.060),但5年DFS腹腔镜组低于开腹组(77.6％ vs.83.9％,P=0.001),Cox比例风险模型分析显示腹腔镜手术是患者5年死亡和复发/死亡的独立危险因素(OS:HR=1.398,95％CI 1.029～ 1.898,P=0.032;DFS:HR=1.540,95％CI 1.220～1.943,P＜0.001).1:2 PSM匹配后共纳入1575例病例,其中腹腔镜组525例,开腹组1050例;腹腔镜组的5年OS和DFS均低于开腹组(OS:82.4％ vs.89.2％,P=0.042;DFS:77.6％ vs.85.0％,P=0.001),Cox比例风险模型分析显示腹腔镜手术是患者5年死亡和复发/死亡的独立危险因素(OS:HR=1.457,95％CI 1.022～2.077,P=0.037;DFS:HR=1.569,95％CI 1.198 ～ 2.054,P=0.001).(2)进一步限定手术类型为QM-B型或QM-C型子宫切除为纳入条件,共入组2066例病例,其中腹腔镜组627例,开腹组1439例;匹配前两组的5年OS差异无统计学意义(82.1％ vs.88.2％,P=0.056),但5年DFS腹腔镜组低于开腹组(77.5％ vs.83.6％,P=0.001),Cox比例风险模型分析显示腹腔镜手术是患者5年死亡和复发/死亡的独立危险因素(OS:HR=1.421,95％CI 1.044～ 1.935,P=0.025;DFS:HR=1.529,95％CI 1.207～1.938,P＜0.001).1∶2 PSM匹配后共纳入1470例病例,其中腹腔镜组490例,开腹组980例;两组的5年OS差异无统计学意义(83.2％vs.88.8％,P=0.126),但5年DFS腹腔镜组低于开腹组(77.5％vs.84.7％,P=0.001),Cox比例风险模型显示腹腔镜手术仅是患者5年复发/死亡的独立危险因素(HR=1.575,95％CI 1.191 ～ 2.081,P=0.001).结论 Ⅰ B2期子宫颈癌患者腹腔镜手术与开腹手术相比,接受腹腔镜手术的患者具有更低的DFS,腹腔镜手术是该期患者复发/死亡的独立危险因素.

Objectives: To compare the oncological outcomes of the first 50 laparoscopic radical hysterectomy (LRH) surgeries with the last 50 LRH, performed by high volume surgeons, for cervical cancer patients. Design : A nationwide multicentre retrospective cohort study Setting : Clinical diagnosis and treatment of cervical cancer patients in mainland China (Four C) database. Population: women with early cervical cancer undergone LRH. Methods: We retrospectively analyzed the oncological outcomes of 1004 cervical cancer patients who underwent LRH performed by 19 surgeons. They were divided into two groups according to the sequence of operations, the first 50 and the last 50 patients with LRH. Kaplan-Meier survival analysis and log-rank test, Cox proportional risk regression model and propensity score matching were used. Main Outcome Measures: 5-year overall survival (OS) and disease-free survival (DFS) rates. Results: There were no significant differences in the 5-year OS and DFS between first 50 patients with LRH group (n=413) and last 50 patients with LRH group (n=591) (OS: p=0.388; DFS: p=0.226). The last 50 cases of LRH was not an independent risk factor for OS and DFS in early cervical cancer patients (p=0.830, p=0.300). After propensity score matching, similar outcomes were observed (n=364:364，OS:P = 0.764; DFS:P = 0.705). Conclusions: The oncological outcomes of the first 50 LRH surgeries were similar to those of the last 50 surgeries in patients with early-stage cervical cancer. Increase in the surgeons’ experience did not improve significantly with oncological outcomes of patients with early stage cervical cancer after LRH.

目的 探讨真实世界研究(RWS)条件下Ⅰ A1 (LVSI+)～ⅡA1期子宫颈癌腹腔镜开腹手术长期肿瘤学结局.方法 从中国子宫颈癌临床诊疗大数据库中筛选接受腹腔镜和开腹手术的Ⅰ A1 (LVSI+)～ⅡA1期子宫颈癌患者,采用RWS及倾向评分匹配(PSM 1∶1)的方法,通过K-M生存分析和Cox多因素分析对两组患者的肿瘤学结局进行比较.结果 (1)经初步筛选纳入Ⅰ A1(LVSI+)～ⅡA1期子宫颈癌14445例,其中腹腔镜组4977例,开腹组9468例;匹配前腹腔镜组与开腹组的5年总体生存率(OS)差异无统计学意义(OS 89.90％ vs.91.40％,P=0.388),但腹腔镜组5年无瘤生存率(DFS)低于开腹组(DFS:85.10％vs.87.60％,P＜0.001),腹腔镜手术是患者死亡及复发/死亡的独立危险因素(HR=1.253,95％CI 1.078～1.455,P=0.003;HR=1.355,95％CI 1.213 ～ 1.514,P＜0.001);1∶1匹配后两组分别纳入4959例,腹腔镜组5年OS、DFS均低于开腹组(OS:89.70％ vs.92.10％,P=0.030;DFS:84.90％vs.88.40％,P＜0.001),腹腔镜手术是患者死亡及复发/死亡的独立危险因素(HR=1.300,95％CI 1.096～1.542,P=0.003;HR=1.373,95％CI 1.209～1.560,P＜0.001).(2)进一步限定行QM-B型或QM-C型子宫切除术的病例共13431例,其中腹腔镜组4750例,开腹组8681例;匹配前两组的5年OS差异无统计学意义(OS 89.90％ vs.91.30％,P=0.370),但是腹腔镜组5年DFS低于开腹组(DFS:85.10％ vs.87.60％,P=0.001),腹腔镜手术是患者死亡及复发/死亡的独立危险因素(HR=1.239,95％CI 1.062～1.445,P=0.006;HR=1.349,95％CI 1.204～ 1.512,P＜0.001);1:1匹配后腹腔镜组和开腹组分别纳入4732例,腹腔镜组5年OS、DFS均低于开腹组(OS:89.90％ vs.92.30％,P=-0.017;DFS:84.80％ vs.88.40％,P＜0.001),腹腔镜手术是患者死亡及复发/死亡的独立危险因素(HR=1.292,95％CI 1.084～ 1.539,P=0.004;HR=1.352,95％CI1.186～ 1.541,P＜0.001).结论 RWS条件下从手术途径方面进行多层次对比分析发现,Ⅰ A1(LVSI+) ～ ⅡA1期子宫颈癌腹腔镜组5年总体生存率和5年无瘤生存率均低于开腹组,腹腔镜手术是复发/死亡的独立危险因素.

Objective To analyze the clinical characteristics and pathological features of patients with perineural invasion by using multi-center data of cervical cancer.Methods The clinical and pathological data of 31 599 patients with cervical cancer were obtained from 34 hospitals in 11 provinces of China from 2004 to 2016.Finally we enrolled 12 931 patients without other treatments before radical hysterectomy in 24 hospitals and retrospectively analyzed the clinical features and their relationship with postoperative pathological factors in patients with PNI.Results The positive rate of PNI in 12 931 cases of cervical cancer was 1.59％ (206/12 931).The positive rate of PNI in patients with stage Ⅱ A cervical cancer was significantly higher than that in patients with stage Ⅰ A-Ⅰ B (x2=122.547,P＜0.01).The positive rate of PNI in endogenous cancer was significantly higher than the other general types of tumor (x2=96.558,P＜0.01).Compared with other pathological types of cervical cancer,PNI was less found in early invasive carcinoma cases (x2=34.071,P＜0.01).The age of PNI-positive group was significantly higher than that of PNI-negative group (t=3.503,P＜0.01).There was no significant difference in terms of histological differentiation,menarche age,number of pregnancies,number of labor,or maximum diameter of tumor between the PNI positive group and the PNI negative group (P＞0.05).The PNI was more likely to be associated with pathological risk factors such as lymph node metastasis,para-uterine metastasis,LVSI,invasive depth and uterine body invasion(P＜0.05).There was no significant difference between the two groups in the risk factors of vaginal resection margin involvement,ovarian metastasis and fallopian tube metastasis (P＞0.05).Multivariate analysis showed that FIGO stage,operative year,cervical invasive depth,LVSI and uterine body invasion were independent risk factors of PNI in cervical cancer(P＜0.05).Conclusion PNI-positive is more likely to occur in endogenous cervical cancer or the cancer with higher FIGO stage,and is less likely to occur in early invasive carcinoma.PNI is more likely to be associated with high risk pathologic factors such as lymph node metastasis,para-uterine metastasis,LVSI,invasive depth and uterine body invasion.FIGO stage,invasive depth greater than 1/2 muscle layer,LVSI,and uterine body invasion are PNI independent risk factors.With the increase of the understanding of PNI,detection rate is gradually increased yearly.

Objective To analyze the clinical characteristics and trends of neoadjuvant chemotherapy (NACT) for cervical cancer by investigating the clinical pathological data of cervical cancer in some hospitals in China,and provide the research basis and data support for the standardized diagnosis and treatment of cervical cancer in China.Methods A retrospective study was performed on the clinical and pathological data of 4503 cases of neoadjuvant chemotherapy from 31 599 cervical cancer cases from 2004 to 2016 in the large database of cervical cancer from 34 hospitals in China.Results In total,31 599 cases were included in the current analysis.There were 25 542 surgical cases,and 4503 cases of neoadjuvant chemotherapy,accounting for 17.6％.The average age of NACT in 4503 cases was 46.82± 8.97 years old.In the past 13 years,the age of treatment has been on the rise.Locally advanced(Ⅰ B2,Ⅱ A2,Ⅱ B)were the main components of NACT cases (accounting for 27.7％,15.5％,23.4％,respectively).Among them,the proportion of Ⅰ B2,ⅡA2 stage (mass type)has an upward trend with time.According to tumor diameter,the cases with diameter of ＞ 4-6.0cm accounted for the highest proportion in NACT and the proportion appeared an upward trend.The ratio of squamous carcinoma 、adenocarcinoma 、adenosquamous carcinoma、neuroendocrine carcinoma,clear cell carcinoma、other pathological types (such as melanoma,lymphatic epithelial carcinoma) were 82.3％、6.8％、1.1％、0.8％、0.2％、0.8％,respectively.There was no linear trend change.The ratio of poorly differentiated showed a trend of increase in neoadjuvant chemotherapy of cervical cancer,The ratio of artery,intravenous,and arteriovenous chemotherapy were 21.3％,21.3％ and 21.3％ respectively.Over time,the rate of intravenous chemotherapy has been on the rise.Chemotherapy drug was mostly based on platinum-based.The number of arterial chemotherapy courses was 1-3,1 course was highest accounted for 90.1％,Intravenous chemotherapy included 1-4 courses,2 course was highest accounted for 58.6％.Conclusion In China,neoadjuvant chemotherapy in the treatment of cervical cancer occupies an important position.Nearly 13 years,the clinical stage,pathological grade,routes of administration,chemotherapy,medication and other aspects have undergone changes.According to the clinical characteristcs and trends of neoadjuvant chemotherapy in cervical cancer,it is more necessary to explore a standard treatment mode.

子宫肌瘤是育龄期妇女最常见的生殖系统肿瘤,子宫腺肌病是由于子宫内膜及问质侵入子宫肌层引起的良性病变,两种疾病均好发于30 - 50岁育龄期妇女.传统的治疗方法有病灶剔除术、子宫次伞切除术及子宫伞切除术等.但是对于年轻、有保留子宫需求的子宫肌瘤患者,病灶剔除术后的两年复发率较高,二次手术的实施有较大的风险及损害.而对于子宫腺肌病患者,一般发病年龄较年轻,有保留子宫的需求,除病灶剔除术以外,可选择LI服避孕药、左炔诺孕酮宫内缓释系统( INC-IUS)及促性腺激素释放激素激动剂(GnRH-a)等保守治疗.

目的 探讨局部晚期宫颈癌术前静脉化疗和术前动脉化疗两种途径化疗方案、疗程及近期疗效的差异.方法 回顾性分析2004--2016年中国大陆地区34家医院30 665例宫颈癌病例,选择术前行静脉化疗或动脉化疗的患者1000例,其中静脉组893例,动脉组107例,以妇科检查结合影像学检查评价新辅助化疗前后病灶大小变化,分析两组在化疗方案、疗程及近期疗效的差异.结果 (1)两组化疗方案可归纳为紫杉醇类+顺铂组、紫杉醇类+非顺铂铂类组、非紫杉醇类+顺铂类组、非紫杉醇类+非顺铂铂类组、铂类单药组、非铂类药物组6组.(2)两组化疗方案差异:静脉组6种方案占比分别为44.12％、31.69％、19.04％、4.82％、0、0.34％;动脉组分别为6.54％、1.87％、66,36％、16.82％、7.48％、0.93％,差异有统计学意义(P＜0.05).(3)两组化疗疗程差异:静脉组1、2、≥3疗程占比分别为37.96％、55.99％、6.05％,平均为(1.68±0.58)疗程;动脉组分别为90.65％、9.35％、0,平均为(1.09±0.29)疗程,差异有统计学意义(P＜ 0.05).(4)两组化疗疗程与近期疗效差异:①分别以化疗1疗程及2疗程为截点,静脉组和动脉组近期总体有效率相近(52.07％vs.50.47％,79.42％ vs.80.00％),差异无显著性意义(P＞0.05);②以最后一次化疗结束为截点,静脉组有628例(70.32％)达到有效标准,化疗1、2、≥3疗程分别为183例(29.14％)、404例(64.33％)和41例(6.53％),平均疗程为(1.77±0.55)个;动脉组有57例(53.27％)达到有效标准,化疗1、2、≥3疗程分别为49例(85.96％)、8例(14.04％)和0例(0),平均疗程为(1.14±0.35)个,整个化疗过程中动脉组平均化疗疗程少于静脉组(P＜0.05).结论 (1)Ⅰ B2期及ⅡA2期局部晚期宫颈癌,术前静脉化疗常使用紫杉醇类+顺铂类方案,以2疗程为主;术前动脉化疗常使用非紫杉醇类+顺铂类方案,以1疗程为主.(2)当使用2疗程以内时,两组化疗有效率相近;当最后一次化疗结束后达到同一疗效时,术前动脉化疗平均疗程数少于术前静脉化疗.

患者49岁,流产1次,未生育,因“不规则阴道流血5个月,发现子宫颈癌1周,阴道大出血1d”入院.入院查体:消瘦,轻度抑郁,阴道大出血,血压85/50 mmHg,脉率90次/分,无发热,腹软,无肌紧张,妇科检查提示:外阴(-),阴道通畅,子宫颈可见5.0 cm ×4.0 cm ×4.0 cm大小肿块,质脆,有活动性出血,骶主韧带无明显增粗.实验室检查血红蛋白6.9 mg/dl.外院宫颈活检病理检查提示:宫颈鳞癌.入院诊断:(1)宫颈高低分化鳞癌IB2期,(2)重度继发性贫血.

目的 观察子宫动脉灌注栓塞化疗对宫颈鳞状细胞癌组织casepase-9表达的影响,探讨介入治疗前后宫颈鳞癌细胞凋亡的规律. 方法 纳入2012年6月至2013年12月青岛大学烟台毓璜顶医院妇科收治的接受双侧子宫动脉灌注栓塞化疗术的IB2期～ⅡB期宫颈鳞状细胞癌患者50例,在介入治疗前、介入治疗后第7天、14天、21天四个时间点行病灶活检,采用免疫组化法检测宫颈鳞癌组织中casepase-9的表达. 结果 介入治疗后四个时间的casepase-9表达有明显差异,介入治疗后第14天与第21天casepase-9表达无明显差异(P＞0.05),但明显高于介入后第7天与介入前的casepase-9表达,差异有统计学意义(P＜0.05),介入治疗前宫颈鳞状细胞癌组织casepase-9的表达最低(P＜0.05). 结论 在双侧子宫动脉灌注栓塞化疗术后随时间推迟,casepase-9的表达逐渐升高,至第14 ～21天casepase-9的表达升高达到稳定状态,为后续进一步治疗选择最佳治疗时机提供理论依据.

目的：研究和分析介入治疗前后宫颈癌中 Caspas －3和 Caspase －9的表达情况。方法选取我院接收治疗的50例宫颈鳞状细胞癌患者，进行术前双侧子宫动脉灌注化疗栓塞术治疗，在介入治疗前后进行 Caspas －3和 Caspase －9检测。结果介入治疗前后宫颈癌中的 Caspas －3、Caspase －9表达有明显差异（P ＜0．05）。结论动脉介入治疗能够缩小患者病灶体积，在动脉介入后患者癌组织中的 Caspas －3、Caspase －9的表达增强，说明介入治疗能够促进癌细胞凋亡从而抑制癌细胞的发展，半胱氨酸蛋白酶（caspase）具有预测肿瘤组织对介入治疗敏感性的作用。

This paper briefly described the pathogenesis and clinical manifestations of cesarean scar pregnancy, and introduced the advantages and disadvantages of HCG (Human Chorionic Gonadotropin), ultrasound, MRI (Magnetic Resonance Imaging), 3D CT (Computerized Tomography) angiography and endoscopy examination methods respectively. Comparisons of laparoscopy and hysteroscopy curettage, abdominal tumor resection surgery and entire womb excision surgery, uterine artery embolization and vaginal surgery were made.

子宫腺肌病是妇科常见病,虽为良性疾病,治疗方法多种,但多种保守治疗效果不佳.近年来介入治疗子宫腺肌病临床效果得到一定认可.良好的手术技巧则是治疗成功的关键.结合自身临床经验,本文分别从股动脉穿刺置管、投照机位选择、路图应用、超选择子宫动脉插管、栓塞操作等方面探讨子宫腺肌病介入手术的技巧.

手术是治疗子宫内膜癌的主要手段,近些年,动脉介入治疗成为子宫内膜癌治疗的新选择.但目前相关研究较少,对于其应用尚无统一意见.今后还需要大规模多中心的随机对照研究对动脉介入治疗在子宫内膜癌治疗中的作用进行评估.

患者女,52岁,因下腹隐痛、腹胀2d、发热1d,于2012年5月27日入住我院妇科.查体:下腹有深压痛,无反跳痛,移动性浊音阳性.妇科检查:盆腔内可扪及直径约10 cm的囊实性肿物,边界尚清,活动欠佳,压痛明显.入院后完善辅助检查:肿瘤标志物CA125 316.7 U/ml,CA199、CEA和AFP均正常.盆腔MRI检查示盆腔内、子宫后上方见巨大、等长T1、较长T2信号肿块影,大小约10.6cm×l0.6 cm×7 cm,内信号混杂,可见类圆形、囊性、长T1、长T2信号影,周围脏器组织受压移位变形,可疑卵巢或输卵管癌.

<正>患者1女性,39岁。因"停经73 d,阴道流血7 d,下腹隐痛3 d",于2007-04-25入本院。病史采集:G2P1,LMP为2007-02-11。73 d前自测尿hCG呈阳性,7 d前出现阴道流血,3 d前下腹隐痛于本院就诊。平素月经欠规律,周期为5~6 d/(2~

目的 探讨华蟾素对子宫内膜癌HHUA细胞基质金属蛋白酶-2 (MMP-2)和金属蛋白酶-2组织抑制剂(TIMP-2)表达的影响及临床意义.方法 体外培养子宫内膜癌HHUA细胞,以子宫内膜癌空白对照组为A组,按不同浓度的华蟾素干预后分为B、C、D组(华蟾素终浓度分别为0.25 mg/ml、2.5 mg/ml、25 mg/ml),应用SABC免疫组化法检测MMP-2和TIMP-2的表达.结果 体外培养的子宫内膜癌HHUA细胞可表达MMP-2和TIMP-2；A、B、C和D组细胞MMP-2表达分别为4.65±0.93、4.27±1.02、3.10±0.92和2.69±0.77;A、B、C和D组细胞TIMP-2表达分别为1.59 ±0.90、2.07±0.92、3.32±1.02和3.88±0.95;B组内膜癌HHUA细胞MMP-2和TIMP-2的表达无显著影响(p＞0.05)；C组子宫内膜癌HHUA细胞MMP-2的表达下降,TIMP-2的表达升高(p＜0.05)；D组与C组对子宫内膜癌HHUA细胞MMP-2和TIMP-2表达的影响无统计学差异(p＞0.05).结论 2.5mg/ml华蟾素可显著降调子宫内膜癌HHUA细胞MMP-2的表达,升调TIMP-2的表达.