宮頸腫瘤-婦科教學(xué)

復(fù)旦大學(xué)附屬婦產(chǎn)科醫(yī)院孫紅病因HPV感染（屬DNA病毒，有很多亞型，低危型：6、11、42、43、44高危型：16、18、31、33、35、39、45、51、52、56或58）性生活紊亂吸煙經(jīng)濟(jì)狀況低下性傳播疾病2.交接部隨體內(nèi)雌激素的水平變化發(fā)生移位。

生理性鱗－柱交接部:移位的SCJ。鱗狀上皮化生

（squamousmetaplasia)鱗狀上皮化（squamousepithelization）病理學(xué)診斷和分級(jí)

I級(jí)II級(jí)III級(jí)輕度不典型增生中度不典型增生重度和原位癌上皮下1/3層上皮下1/3~2/3層占據(jù)上皮全層細(xì)胞核增大核明顯增大核異常增大核質(zhì)比例略增大核質(zhì)比例增大顯著增大核染色稍加深核深染核染色較深核分裂相少核分裂相較多核分裂相增多細(xì)胞極性保存細(xì)胞極性尚存無極性TBS診斷系統(tǒng)LSIL（low-gradesquamousintraepitheliallesion）相當(dāng)于CINI。HSIL（high-gradesquamousintraepitheliallesion）相當(dāng)于CINII和III。臨床表現(xiàn)診斷治療CancersoftheFemaleReproductiveTract:

WorldwideStatistics1

Ferlay

etal.GLOBOCAN2000IARC,WHO2001(www.dep.iarc.fr)

CancerNewCasesDeathsCervical470,000230,000Endometrial189,00045,000Ovarian192,000114,000USANorthernEuropeSouthernEurope23,80010,00010,20015,6007,2006,200PreventablecancerLongpreinvasivestateAvailablecervicalcytologyscreeningprogramEffectivetreatmentofpreinvasivelesions病因流行病學(xué)資料：危險(xiǎn)因素1.婚育史：早婚、早年分娩、密產(chǎn)、多產(chǎn)2.初次性生活過早,性生活紊亂3.病毒（單純皰疹病毒II型herpessimplexvirus，人乳頭瘤病毒humanpapillomavirus16、18、33、35及45亞型、人巨細(xì)胞病毒humancytomegalovirus）4.高危男子5.吸煙病理病理病理病理直接蔓延最常見。癌組織局部浸潤(rùn)，向鄰近器官及組織擴(kuò)散。TheFIGOStagingSystemforCervixCancerIcarcinomaconfinedtocervixIAInvasivecanceronlymicroscopically.

Allgrosslesions,stageIBstromalinvasionwithamaximumdepthof5mmandnowiderthan7mm.

Vascularspaceinvolvement,eithervenousorlymphatic,notalterthestaging.)IA1invasionstromanogreaterthan3mmindepthandnowiderthan7mm.IA2invasionstromagreaterthan3mmandnogreaterthan5mmindepthandnowiderthan7mm.IBlesionsgreaterthanIA.IB1lesionsnogreaterthan4cminsize.IB2lesionsgreaterthan4cminsize.IIThecarcinomaextends，notextendedontothepelvicwall;involvesthevagina,notasfarasthelowerthird.IIaNoobviousparametrialinvolvement.IIbObviousparametrialinvolvementIIIextendedontothepelvicwall;involvesthelowerthirdofthevagina;witha

hydronephrosisornonfunctioningkidneyshouldbeincludedIIIainvolvementthelowerthirdofthevagina.

IIIbExtensiontothepelvicwallorhydronephrosisornonfunctioningkidney.IVextendedbeyondthetruepelvisorhasinvolvedthemucosaofthebladderorrectum.IVaSpreadofthegrowthtoadjacentorgans.IVbSpreadtodistantorgans.

臨床表現(xiàn)癥狀陰道流血尤其接觸性出血，發(fā)生在性生活后或婦科檢查后。（1）早期：流血量少；晚期：流血量大。（2）外生型癌：出血早，血量多。內(nèi)生型癌：出血晚，血量少。（3）年輕患者也可表現(xiàn)月經(jīng)失調(diào)；老年患者絕經(jīng)后陰道流血。體征診斷6.其他檢查：胸部x線攝片，淋巴造影，膀胱鏡，直腸鏡檢查等，以協(xié)助確定