【作者】 金力；

【导师】 郎景和； 王友芳； Jeffery Tan； Michael Quinn；

【作者基本信息】 中国协和医科大学 ， 妇产科， 2005， 博士

【摘要】 CIN的当前治疗与术后随诊模式的研究及P16^INK4a与HPVDNA杂交捕获Ⅱ检测在CIN诊断和随诊中的价值 研究背景 由于细胞学筛查技术的迅速发展，使得宫颈癌前病变的早期诊断成为可能。同时治疗方法也逐渐标准化：CO₂激光以及LEEP目前已成为治疗CIN的主要方法，特别是对年轻、要求保留生育功能的妇女。但在行局部破坏性治疗或LLETZ治疗后均有一定数目的复发，因此，加强治疗后的随诊及了解与复发有关的危险因素对于预防复发与治疗同样是非常重要的。对于激光治疗不同级别CIN的预后及细胞学联合阴道镜随诊的模式是否优于单独细胞学，目前国内尚无研究。已有文献报道，LLETZ术后影响CIN复发的因素是复杂、多因素的，各家报道结果也不完全一致。对于LLETZ切除CIN标本边缘的详细分析以及标本大小、数目等相关因素尚未见报道。采用新的，更为敏感的方法用于术后随诊是当今研究的热点，如何提高目前现有随诊筛查方法的准确性，及时发现具有复发高危因素的人群具有重要意义。 宫颈腺癌发生率目前占所有宫颈发生率的19％-25％，使用目前的筛查方法对宫颈腺癌的癌前病变的诊断率较低，是宫颈腺癌发生率呈上升趋势的一个主要原因之一。流行病调查结果发现，ACIS在生育年龄的妇女中发生率较高。因此，美国ASCCP以及澳大利亚的宫颈病变临床治疗规范中提出对生育年龄、要求保留生育能力的ACIS或宫颈腺癌IA（1）的患者可实施保守性手术治疗，而对于已生育或不再要求生育的妇女可实施单纯全子宫切除术。对于切缘阳性的妇女可进一步锥切，否则行全子宫切除术。在我国ACIS的发生率也有升高的趋势，但实施保留生育能力手术的妇女为数不多，因此，对于实施保留生育功能手术的ACIS患者的诊断、手术方法及术后随诊模式及预后的研究，对如何管理年轻ACIS患者的具有重要的指导意义。更多还原

【Abstract】 Study on current protocols for CIN treatment and post-operative follow up and the value of p16^INK4a and HPV hybrid capture II used in diagnosis for CIN and post-treatment follow-upBACKGROUNDWith the rapidly development of cytology screen technology, it makes it possible for early diagnosis cervical precancer before it change into cancer. Meanwhile, the main treatment modalities for the management of histological proven CIN, such as CO₂ laser vaporization and conization have been the most effective methods for CIN, especially for young women who want to keep their fertility. But recurrence of CIN after local treatment indicates the necessary and importance for understand the risk factors related to recurrence for surveillance patients. It was reported that the factors effect the relapse of CIN were complicated and multi-factors.The procotols for post-operative follow up is the focus on this field at present .How to improve the accuracy of the screening methods for follow up and find the group people with high risk factors for recurrence and reduce the frequencies of low risk group of patients are very important.The incidence of adenocarcinoma now account for as many as 19% of all cervical cancers. One of the reason is that cervical screening is less effective at preventing cervical adenocarcinoma than squamous carcinoma. Adenocarcinoma or ACIS is also significantly related to HR-HPV infection. Epidemiological investigation showed that the incidence of ACIS among reproductive women was high. Therefore, ASCCP and Australia National Cervical Intraepithelial Neoplasma Diagnosis and Treatment guidelines suggest that conservative operation can be performed on young women with ACIS or adenocarcinoma LA （1） desiring to keep their reproductive capactivity, hysterectomy is recommended for young women who already have completed child bearing. If the margins of the initial cone biopsy are involved by ACIS, then a further更多还原