【正文】 理能力，需要住院和積極的支持治療重危，臨近死亡死亡35附 錄 2宮頸/陰道細(xì)胞學(xué)診斷Bethesda報(bào)告系統(tǒng)報(bào)告格式：標(biāo)本量對(duì)診斷評(píng)價(jià)的意義：評(píng)價(jià)滿意評(píng)價(jià)滿意但是受限于（具體原因）評(píng)價(jià)不滿意（具體原因）診斷總的范圍（最適的）正常范圍內(nèi)良性細(xì)胞學(xué)改變：見(jiàn)描述性診斷上皮細(xì)胞異常：見(jiàn)描述性診斷描述性診斷：良性細(xì)胞學(xué)改變： 感染： 滴蟲(chóng)陰道炎 真菌形態(tài)符合念球菌屬以球形菌為主的陰道菌群失調(diào)微生物形態(tài)符合放線菌屬細(xì)胞學(xué)改變符合單純皰疹病毒感染其它反應(yīng)性改變：與下列因素有關(guān)的反應(yīng)性細(xì)胞學(xué)改變：炎癥（包括典型修復(fù)細(xì)胞）炎癥性萎縮（萎縮性陰道炎）放療宮內(nèi)節(jié)育器(IUD)的影響其它上皮細(xì)胞異常：鱗狀上皮細(xì)胞：鱗狀上皮內(nèi)低度病變包括： HPV+ * 輕度非典型增生/CIN1 鱗狀細(xì)胞癌腺上皮細(xì)胞：未明確診斷意義的不典型腺細(xì)胞*子宮內(nèi)膜腺癌腺癌，非特異性與年齡和病史相符的激素水平模式特異性（NOS）特異性CIN：宮頸上皮內(nèi)病變；CIS：原位癌*不明意義的非典型鱗狀/腺細(xì)胞應(yīng)進(jìn)行進(jìn)一步追查，以證實(shí)是反應(yīng)性還是癌前病變或癌。附 錄 3放射及化學(xué)治療療效判定標(biāo)準(zhǔn)1 WHO實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)（1981） 完全緩解(CR)，腫瘤完全消失超過(guò)1個(gè)月。 病變穩(wěn)定(SD)，病變兩徑乘積縮小不超過(guò)50%，增大不超過(guò)25%，持續(xù)超過(guò)1個(gè)月。 2 RECIST療效評(píng)價(jià)標(biāo)準(zhǔn)(2000) 靶病灶的評(píng)價(jià) 完全緩解（CR），所有靶病灶消失。 病變進(jìn)展（PD），靶病灶最長(zhǎng)徑之和與治療開(kāi)始之后所記錄到的最小的靶病灶最長(zhǎng)徑之和比較，增加20%，或者出現(xiàn)一個(gè)或多個(gè)新病灶。 非靶病灶的評(píng)價(jià) 完全緩解（CR），所有非靶病灶消失和腫瘤標(biāo)志物恢復(fù)正常。 病變進(jìn)展（PD），出現(xiàn)一個(gè)或多個(gè)新病灶和/或已有的非靶病灶明確進(jìn)展。通常，病人最好療效的分類由病灶測(cè)量和確認(rèn)組成。據(jù)統(tǒng)計(jì), 每年約有50萬(wàn)左右的宮頸癌新發(fā)病例, 占所有癌癥新發(fā)病例的5%, 其中的80%以上的病例發(fā)生在發(fā)展中國(guó)家?；疾〉母叻迥挲g為4060歲左右。宮頸癌發(fā)病率分布有地區(qū)差異，農(nóng)村高于城市，山區(qū)高于平原，發(fā)展中國(guó)家高于發(fā)達(dá)國(guó)家。另一方面，宮頸癌的發(fā)生可通過(guò)對(duì)癌前病變的檢查和處理得以有效控制。為了降低我國(guó)宮頸癌的發(fā)病率，做到早診早治，本指南補(bǔ)充了宮頸癌前病變的診治原則，希望能降低宮頸病變的危害，同時(shí)減少國(guó)家對(duì)宮頸癌的診治支出。57: 4366. 2. Howe HL, Wu X, Ries LA, et al. Annual report to the nation on the status of cancer, 19752003, featuring cancer among . Hispanic/Latino populations. Cancer 2006。103(6):12581264. 4. Parkin DM, Bray F, Ferlay J. Global cancer statistics, 2002. CA Cancer J Clin 2005。24(14):21372150. 6. Villa LL, Costa RL, Petta CA, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 viruslike particle vaccine in young women: a randomized doubleblind placebocontrolled multicentre phase II efficacy trial. Lancet Oncol 2005。 Future II Study Group. Effect of prophylactic human papillomavirus L1 viruslikeparticle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a bined analysis of four randomised clinical trials. Lancet 2007。356(19):19151927. 9. Arbyn M, Dillner J. Review of current knowledge on HPV vaccination: an appendix to the European Guidelines for Quality Assurance in Cervical Cancer Screening. J Clin Virol 2007。78:7991. 11. Chi DS. Laparoscopy in gynecologic malignancies. Oncology 1999。70:209262. 13. Landoni F, Maneo A, Colombo A, et al. Randomized study of radical surgery vs. radiotherapy for stage IbIIa cervical cancer. Lancet 1997。25(19):28042810. Epub 2007 May 14.15. Monk BJ, Tewari KS, Koh WJ. Multimodality therapy for locally advanced cervical carcinoma: state of the art and future directions. J Clin Oncol 2007。25(17):23832388. 17. HaieMeder C, Fervers B, Fondrinier E, et al. SOR guidelines for conitant chemoradiotherapy for patients with uterine cervical cancers: evidence update bulletin 2004. Ann Oncol 2005。s fertility. Gynecol Oncol 2004。189:13781382. 20. Boss EA, van Golde RJ, Beerendonk CC, et al. Pregnancy after radical trachelectomy: A real option? Gynecol Oncol 2005。98(1):310.22. Marchiole P, Benchaib M, Buenerd A, et al. Oncological safety of laparoscopicassisted vaginal radi cal trachelectomy (LARVT or (LARVH). Gynecol OncolDargent39。106(1):132141. Epub 2007 May 9.23. Shepherd JH, Spencer C, Herod J, Ind TE. Radical vaginal trachelectomy as a fertilitysparing procedure in women with earlystage cervical cancercumulative pregnancy rate in a series of 123 women. BJOG 2006。17(3):623628. Epub 2007 Feb 16. 25. Shimada M, Kigawa J, Nishimura R, et al. Ovarian metastasis in carcinoma of the uterine cervix. Gynecol Oncol 2006。340:11541161.27. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy pared with pelvic and paraaortic radiation for highrisk cervical cancer. N Engl J Med