??????HPV

1
?????????

• ?????? ???
• ???

2
??????HPV
???????50?/?,??????? ???????13?/? ????????,????
?? ?????????2?/? ????????? ?????HPV?? ?HPV???
???,????10-20? ???????,???????
3

4
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2010?EUROGIN??

• ??HPV???????????????HPV??????????

8
HPV??????-??????

• 30???,???????????????,HPV16?18??,??????
• 2006 consensus guidelines for management
  of women with abnormal cervical cancer screening
  tests
• www.AJOG.ORG

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CIN???

• ????HSIL30??
• LSIL100??
• ????HSIL1000??
• LSIL340000??

10
CIN???

• ???
• ???
• ?????

11
???

• ????????????
• ??????
  ?????
  ??????
• ?????

12

• CIN??????

• Acetowhite area Colour, surface contour, margins
  
• Vasculature punctation, mosaicism
• Iodo-negative mustard/saffron yellow areas

• Coarse mosaic

• Acetowhite area

• Fine mosaic

• Fine punctation

• Coarse punctation

• Umbilication

13
???????,??ECC??

• ??????????????????????/????????????
• ???????????????AGC/????????????AGC??
• ??????????????
• ?????????????????CIN1???????????
• ECC?????????,?????????????

14
????? ???? ???? ??????

• CIN3??????????,??????,?CIN3-CIS????,?????????

15
CIN????

• 2001?/2006?,ASCCP?????????????????????
• 2001?/2006?,ASCCP?????????CIN(???)?????????
• (ASCCPthe American Society for Colposcopy and
  Cervical Pathology)

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• HSIL70-75???????CIN2-3
• LSIL10-30???????CIN2-3
• ASC??0.1-0.2,
• 5-17???????CIN2-3
• ASC-US5???????CIN2-3
• ASC-H24-94???????CIN2-3
• 26-68???????CIN2-3

17
ASC-US??(?????????????)

• ???78ASC-US???
• ???????(6?????)
• HPV?????????
• ??????(12?????)
• FDA?HPV????ASC-US?????

18
ASC-US??(20?)

• 12??????????
• ?HSIL ,?????
• ?lt HSIL,12???????

19
ASC-H??

• ??????

20
AGC?AIS???

• ???ECC
• 35?,???,???????
• ????AIS
• ?????,?????
• ?????,?????(?????),?????????,???,HPV,TCT?

21
CIN??(???????)

• ????(?????)
• CO2??
• ??
• ??
• ????leep
• ??
• ??
• ????
• ???20?????????????????

???????
22
CIN1??(???????)

• ?????,??CIN1
• HPV??()??,()??
• ??6-12??,TCT
• ??????????(????)
• ??????,??CIN1
• ?????
• ?????(Leep???)

23
CIN1?????

• ????????????

24
????ASC-US?ASC-H?LSIL???????CIN1??

• ??????,?????
• ????
• 12??HPV-DNA???6-12??????????
• HPV-DNA()????????ACS-US????????
• 12???HPV-DNA()???2????????????,???????
• CIN1????2???,??????????

25
????HSIL?AGC-NOS???????CIN1??

• ???????,???????????????
• ?1????6????????????
• ????????????????,???????,??????????????????
• ????????,?????????
• 6?12?????????????HSIL?AGC-NOS,?????????
• 1????,??2????????????????????

26
????CIN1???(???,13-20?)

• 1?1???????
• 12????,???HSIL,????
• 24????,???ASC-US,????
• HPV??????

27
CIN2?3???

• ???????????????????(??????)?
• ??????????????????
• ?????????CIN2?3??????

28
?????CIN2?3??(???)

• ?????(????????????)???(24?????6????????????)
• ?????CIN2????
• ?????CIN3?????????????
• ???,???HSIL????????????1???,?????
• ??2??????,??????,?????????
• ?????CIN2?3,??24??,?????

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CIN2?3???--Cold Knife Conization(CKC)

• ???????
• ????????????
• ????,??,????,??
• ?????(???????????)
• ???????????????????,????????

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CIN2?3???--??????

• ??????????????,?????????????????
• ??CIN2?3?????,???????????????????,????????????????
  ?
• ?????,????????????????7.4?

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CIN2?3??--Leep(Loop electrosurgical excision
procedure)

• See and treat,?????????,????HSIL?
• ????????????
• ECC??
• ?????????CIN
• ???CIN2?3??

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???????,???????????

1. ??ECC????
2. ?????????LSIL??????????????????
3. ?????????????(gt??)????????????????
4. ??????????HSIL,?????????????(??/????) ?
5. ??????????????
6. ECC????????????

33
???????,???????????

1. ?????CIN2,3?(lt20???????????????)?
2. ??????a1???????????(????????????????)?
3. ?????????(CIN2,3???)?CIN2,3????46??????

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• LEEP????

35
Cowboy-hat ? LEEP
36

• LEEP????

• LEEP??????????10-16mm??

37

• CIN???????CIN????????

38

• ??????????,??????,?????????????

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(No Transcript)
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• ???,??????,???????????????

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(?)??CIN???

• ??????????????????6?????,????6????????,???????
• ???CIN??????,????????????????????,??????
• ?CIN????,????????,??????????????,?????????,????,??
  ????,???????????
• ?????????,???????(??),?????????,???????10mm???????
  ??,???????

43
????????????

• (?)????????????
• 1  ?????????????(AGC),??AGC??,??????????????????
• 2  35???AGC???35???????????????AGC????????????
• 3  ?AGC?????????????
• 4  ?AGC-NOS????CIN,?CIN???????
• 5 ?AGC-NOS?????,????,46????,??4??????,?????????

44
(?)??????????

• 1  ????????????????,?????????????,??????3cm?
• 2  ???????????,???????????,???CIN???????????????
• 3 ???????,????,????????????,???????????,?????????
  ????,????,?????

45
2009?NCCN???

• ??
• ???
• 1-2??3-6????
• 3-5??6????
• gt5???????