全面检查让宫颈癌无处可逃

全面检查让宫颈癌无处可逃 一、临床检查 1.阴道脱落细胞检查（宫颈细胞刮片检查） 为发现早期宫颈癌最有效的检查方法。 由于早期癌病人大多数没有明显症状，临床检查时医生单凭肉眼观察很难辩认是否存 在肿瘤，因此早期宫颈癌很少能及时被发现。宫颈暴露在阴道顶端，易于观察和取材， 所以目前在临床对凡已婚妇女，妇科检查或防癌普查时，都常规进行阴道脱落细胞检 查，作为筛查手段。使宫颈早期癌的诊断阳性率大大提高，可达 90%以上。为了提高涂 片诊断的准确率，特别注意要从宫颈癌好发部位即鳞状上皮与柱状上皮交界处取材。 由于老年妇女鳞、柱状上皮交界区向颈管内上移，取材时除了从宫颈阴道处刮取涂片 外，还应从宫颈管处取材涂片，以免漏诊。 2.阴道镜检查 阴道镜可放大 640 倍，用以观察宫颈血管及组织的变化，可提高 原位癌诊断 710 倍，与病理诊断符合率为 78%。阴道镜可选择活体组织检查部位，协 助对于阴道细胞学涂片可疑者找到早期病变的部位、范围、性质和程度，但不能发现 鳞柱交界或延伸宫颈管内的病变，不能代替宫颈刮片或活检。 3.宫颈摄影 用 10mm 显微镜附加 35mm 相机及 50mm 延伸圈组成摄影仪，将所获图 像投射在宽 3.3m 屏幕上，1m 远处观察；鳞柱交界处全部显示，无异常为阴性，发现异 常为可疑，未见鳞柱交界为不满意。有人观察其诊断准确率为 93.1%，故为一种准确性 高，成本低，便于应用的新方法。 4.碘试验 将浓度为 2%的碘溶液直接涂在子宫颈和阴道粘膜上，不着色处为阳性， 帮助提供活体组织检查部位。 5.活体组织检查 宫颈在临床所进行的各项检查都是诊断的重要环节，但是活检是 诊断宫颈癌最可靠的依据。在碘试验或阴道镜检查可疑部位取材作病理检查。如果宫 颈表面未见肿瘤，需要刮取颈管内组织送病理检查。 6.宫颈锥形切除术 当宫颈细胞刮片检查多次为阳性，而多点活检及颈管刮术阴性， 或已证明为原位癌，不能排除浸润癌者，可行宫颈锥切术并送病理。此种方法即达到 诊断的目的又将病灶一并切除，被认为是一举两得的方法。因锥切术后有不同程度的 并发症，目前在临床多不采用，如果作为治疗手术可以全子宫切除术取代。 7.荧光检查法 利用癌组织与正常组织吸收荧光素多少不同而显示不同颜色的机理 诊断有无癌变。癌组织吸收荧光素多，产生的荧光比正常组织强而呈深黄色，正常组 织为紫蓝色。 8.肿瘤生化诊断 通过学者临床研究发现，在宫颈癌病人体内，乳酸脱 氢酶、已糖激酶明显增高，尤其有浸润者更明显，有助于临床诊断。 二、其他检查 视每个病例的具体情况可以行膀胱镜、直肠镜、肾图、肾盂造影、 胸片、骨盆相应检查，必要时可进行 CT 扫描或 MRI 检查，对确定病变的范围，选择恰 当的治疗方法，提高治疗率，判断预后等，很有必要的。 内诊检查 双合诊、三合诊， 可触及宫颈局部变硬、粗大，或为突起的块状物。子宫一般不大。宫旁可有不同程度 增厚、弹性消失或呈团块状。早期可无其他阳性发现 。 Nowhere to run to make a comprehensive examination of cervical cancer A clinical examination 1. vaginal cytology (cervical smear) to detect early cervical cancer the most effective method. Since most of the early cancer is no obvious symptoms, clinical examination alone when the doctor is difficult to visually recognizable whether there is cancer, early cervical cancer is rarely to be found in time. Cervix exposed top of the vagina, easy to observe and drawn, so now in clinical married women who, when gynecological examination or anti-cancer screening are routine vaginal cytology as a screening tool. Making early diagnosis of cervical cancer, the positive rate greatly increased, up to 90%. In order to improve the accuracy of diagnosis of smear, special attention from the cervical squamous epithelium that is a good site at the junction of columnar epithelium derived. Because elderly woman scales, columnar epithelial junction to the neck tube on the move, when drawn in addition to scraping smear from the cervix and vagina at the outside, but also derived from cervical smears place to avoid misdiagnosis. 2. colposcopy colposcopy can zoom from 6 to 40 times, to observe changes in the cervical vessels and tissue, can improve the diagnosis of carcinoma in situ of 7 to 10 times, and the pathological diagnosis was 78%. Alternatively colposcopy biopsy site help for vaginal cytology suspicious lesions were found on the site early, scope, nature and extent of, but can not find squamous columnar junction or extended lesions cervical canal, can not replace the Pap smear or biopsy . 3. cervical photography with 10mm and 50mm 35mm camera microscope additional extension ring composed of photographic apparatus and the resulting image is projected on a wide screen 3.3m, 1m distance observation; full scale columnar junction showed no abnormalities were negative, unusual for the Suspicious, no scale columnar junction is not satisfied. It was observed that the diagnostic accuracy was 93.1%, it is a high accuracy, low cost, ease of application of new methods. The iodine test the concentration of 2% iodine solution directly on the cervix and vaginal mucous membrane, not colored at the positive, helping to provide a biopsy site. 5. cervical biopsy important part in the examination is conducted clinical diagnosis, but biopsy is the most reliable basis for diagnosis of cervical cancer. Iodine test or colposcopy suspicious sites drawn for pathological examination. If the surface of the cervix no tumor, need to scrape endocervical tissue sent to pathology. 6. cervical conization cervical smear when many were positive, and multiple biopsies of neck tube curettage negative, or has proved to be carcinoma in situ, invasive carcinoma can not be excluded, feasible conization and sent pathology. That is the purpose of this method of diagnosis of lesions in turn be removed, is considered to be achieved through the method. Conization because there are different degrees of complications, many do not currently in clinical use, can replace hysterectomy as a treatment if surgery. 7. fluoroscopy use of cancer tissue and normal tissue to absorb fluorescein and show how many different mechanisms in different colors whether the cancer diagnosis. Cancer tissues absorb fluorescein more than normal tissue fluorescence intensity and dark yellow, purple and blue normal tissue. 8. Cancer diagnosis through clinical biochemistry researchers found that in cervical cancer patient, lactate dehydrogenase, hexokinase significantly increased, particularly infiltration were more obvious, help the clinical diagnosis. Second, other tests depending on the specific circumstances of each case can row cystoscopy, colonoscopy, renogram, urography, chest, pelvis appropriate checks can be carried out CT scans or MRI, if necessary, to determine the scope of the lesion, select the appropriate treatment methods to improve treatment rates, progno