力大圖書

陰道鏡臨床相關應用圖解 2011
鐘坤井醫師
Pub Date :3月12日 2011
Page: 186

Ⅰ . 序一.......................................................................................................... Ⅲ
Ⅱ . 序二.......................................................................................................... Ⅴ
Ⅲ . 前言.......................................................................................................... Ⅶ
第一篇子宮頸細胞......................................................................................... 1
第一章正常細胞之構造與功能.......................................................................................... 1
( 一) 電子顯微鏡下之細胞胞器.......................................................................................... 1
( 二) 光學顯微鏡下之細胞胞器.......................................................................................... 1
( 三) 細胞(Cell) ................................................................................................................... 2
第二章子宮頸部上皮組織.................................................................................................. 4
( 一) 子宮頸鱗狀細胞(Cervical sguamous cell)............................................................ 4
( 二) 子宮頸柱狀細胞(Cervical columnar cell).............................................................. 4
( 三) 鱗狀細胞之成熟指數(Squamous cell maturation index).................................. 5
第三章正常與不正常鱗狀上皮變化之細胞圖說............................................................. 6
( 一) 正常鱗狀上皮(N.S.E)................................................................................................. 6
( 二) 輕度鱗狀上皮內病變(LSIL)...................................................................................... 6
輕度子宮頸上皮內贅瘤(CIN-1)............................................................................... 6
輕度異形上皮病變(Mild dysplasia.................................................................................................. 6
( 三) 重度鱗狀上皮內病變(HSIL)..................................................................................... 7
中度子宮頸上皮內贅瘤(CIN-2)............................................................................... 7
中度異形上皮病變(Moderate dysplasia..................................................................................... 7
( 四) 重度鱗狀上皮內病變(HSIL)..................................................................................... 7
重度子宮頸上皮內贅瘤(CIN-3)............................................................................... 7
重度異形上皮病變(Severe dysplasia............................................................................................ 7
( 五) 原位癌(Carcinoma In Situ，CIS)............................................................................ 7
( 六) 鱗狀上皮癌(Sguamous Cell Carcinoma，SCC).................................................. 7
第四章比較細胞學報告之使用不同術語......................................................................... 8
( 一) 柏式分類法(Papanicolaou classification)............................................................. 8
( 二) 世界衛生組織(WHO) 分類法................................................................................... 8
( 三) 子宮上皮內贅瘤(CIN) 分類法.................................................................................. 8
( 四) 貝塞斯達系統(Bethesda) 系統分類法................................................................... 8
目錄
陰道鏡臨床相關應用圖解ATLAS OF INTEGRATED COLPOSCOPY
VIII
第五章簡單說明常見之臨床細胞學圖譜.....................................................................................9
( 一) 正常子宮頸鱗狀細胞(Normal cervical squamous cell)............................................. 9
( 二) 正常子宮頸柱狀細胞(Normal cervical columnar cell)............................................. 10
( 三) 子宮內膜細胞(Endometrial cell)................................................................................... 11
( 四)(1) 慢性淋巴球或濾泡性子宮頸炎(Lymphocytic or Follicular cervicitis)............. 12
(2) 萎縮性相關之反應性細胞變化(Reactive cellular change associated with
Atrophy)...................................................................................................................... 12
(3) 組織球(Histiocyte)..................................................................................................... 12
( 五) 白色念珠菌類(Candida spp.)........................................................................................ 13
( 六) 線團細胞與放線菌屬(Clue cells and Actinomyces)................................................ 14
( 七) 陰道滴蟲(Trichomonas vaginalis)............................................................................... 15
( 八) 單純性泡疹病毒感染(Herpes simplex virus infection)........................................... 16
( 九) 披衣菌屬感染細胞(Chlamydial infected cell)............................................................ 17
( 十) 修復細胞(Repair cell)..................................................................................................... 18
( 十一) 子宮頸鱗狀化生上皮(Cervical squamous metaplasia)....................................... 19
( 十二) 輕度鱗狀上皮內病變(LSIL.CIN-1.Mild dysplasia).............................................. 20
( 十三) 重度鱗狀上皮內病變(HSIL.CIN-2.Moderate dysplasia)................................... 21
( 十四) 重度鱗狀上皮內病變(HSIL.CIN-3.Severe dysplasia )...................................... 22
( 十五) 原位癌又叫上皮內癌(HSIL.Carcinoma In Situ，CIS.CIN-3)............................. 23
( 十六) 鱗狀上皮癌(Squamous Cell Carcinoma，SCC)................................................... 24
( 十七) 子宮頸原位腺癌(Adenocarcinoma In Situ，AIS)................................................ 25
( 十八) 子宮頸腺癌(Cervical adenocarcinoma).................................................................. 26
( 十九) 子宮內膜腺癌(Endometrial adenocarcinoma)...................................................... 27
( 二十) 鳥類眼睛樣細胞(Bird eye cell-like).......................................................................... 28
第六章子宮頸抹片採樣應有之基本認識............................................................................... 29
( 一) 貝塞斯達系統(The Bethesda System 簡稱TBS) 抹片採樣品質之判讀.............. 29
( 二) 子宮頸抹片採樣範例........................................................................................................ 31
( 三) 材料與方法........................................................................................................................ 33
( 四) 各種不同採樣器具............................................................................................................ 38
( 五) 總結.................................................................................................................................... 43
第二篇陰道鏡.................................................................................................... 44
第一章在臨床上實際使用陰道鏡之說明............................................................................... 45
( 一) 陰道鏡之介紹.................................................................................................................... 45
目錄
IX
( 二) 陰道鏡檢查儀器................................................................................................................ 46
( 三) 陰道鏡之訓練.................................................................................................................... 47
( 四) 於陰道鏡觀察下塗抹在外子宮頸表面上
各種不同溶液測試變化之基本認識.............................................................................. 49
( 五) 各種不同溶液與塗抹在外子宮頸部之測試範例如下................................................. 51
( 六) 在子宮外頸布圖5% 醋酸加工後以肉眼來觀察表面上皮變化情形........................ 55
( 七) 子宮外頸部陰道鏡所見之正常所見解剖圖表.............................................................. 57
( 八) 在陰道鏡觀察下正常與不正常移行帶之所見.............................................................. 60
( 九) 陰道鏡下各種不同血管圖譜........................................................................................... 63
( 十) Coppleson 不正常移行帶分級系統介紹...................................................................... 66
( 十一) 國際子宮頸病理學會與陰道鏡學會聯盟之陰道鏡術語分類................................ 67
( 十二)Reid's 陰道鏡指數摘要(Reid's index)..................................................................... 68
( 十三) 陰道鏡報告與繪圖模式............................................................................................... 71
第二章繪圖說明子宮頸陰道鏡之所見................................................................................... 73
( 一) 正常子宮外頸部(Normal ectocervix).......................................................................... 73
( 二) 正常子宮外頸部(Normal ectocervix).......................................................................... 74
( 三) 萎縮之子宮頸(Atrophic cervix)................................................................................... 75
( 四) 陰道毛滴蟲 (Trichomonas vaginalis)........................................................................... 76
( 五) 正常未成熟移行帶(Normal immature transformation zone)................................ 77
( 六) 柱狀上皮與正常成熟移行帶
(Columnar epithelium with normal mature transformation zone) ..................... 78
( 七) 正常不成熟與成熟移行帶
(Normal imature and mature transformation zone)............................................... 79
( 八) 正常成熟移行帶及腺開口
(Normal mature transformation zone with gland opening)................................. 80
( 九) 正常成熟移行帶(Normal mature transformation zone)......................................... 81
( 十) 正常成熟移行帶(Normal mature transformation zone)......................................... 82
( 十一) 正常成熟移行帶(Normal mature transformation zone).................................... 83
( 十二) 正常移行帶與腺體囊腫
(Normal transformation zone with nabothian cyst).......................................... 84
( 十三) 正常移行帶與腺體囊腫
(Normal transformation zone with nabothian cyst).......................................... 85
( 十四) 移行帶與腺體囊腫(Transformation zone with nabothian cyst)..................... 86
( 十五) 尖頭濕疣(Condylomata accuminata)..................................................................... 87
陰道鏡臨床相關應用圖解ATLAS OF INTEGRATED COLPOSCOPY
X
( 十六) 輕度鱗狀上皮內病變與人類乳突病毒感染
(Low-grade Squamous Intraepithelial Lesion,LSIL.HPV infection)............................... 88
( 十七) 輕度鱗狀上皮內病變與人類乳突病毒感染
(Low-grade Squamous Intraepithelial Lesion,LSIL.HPV infection).................. 89
( 十八) 重度鱗狀上皮內病變(High-grade Squamous Intraepithelial Lesion.HSIL)..... 90
( 十九) 重度鱗狀上皮內病變(High-grade Squamous Intraepithelial Lesion.HSIL)..... 91
( 二十) 重度鱗狀上皮內病變(High-grade Squamous Intraepithelial Lesion.HSIL)..... 92
( 二十一) 重度鱗狀上皮內病變(High-grade Squamous Intraepithelial Lesion.HSIL)..... 93
( 二十二) 重度鱗狀上皮內病變(High-grade Squamous Intraepithelial Lesion.HSIL).... 94
( 二十三) 重度鱗狀上皮內病變(High-grade Squamous Intraepithelial Lesion.HSIL)..... 95
( 二十四) 重度鱗狀上皮內病變(High-grade Squamous Intraepithelial Lesion.HSIL)..... 96
( 二十五) 重度鱗狀上皮內病變(High-grade Squamous Intraepithelial Lesion.HSIL).... 97
( 二十六) 重度鱗狀上皮內病變(High-grade Squamous Intraepithelial Lesion.HSIL)..... 98
( 二十七) 子宮頸原位癌(Cervical Carcinoma In Situ,CIS.CIN-3.HSIL).......................... 99
( 二十八) 子宮頸原位癌(Cervical Carcinoma In Situ,CIS.CIN-3.HSIL)....................... 100
( 二十九) 子宮頸原位癌(Cervical Carcinoma In Situ,CIS.CIN-3.HSIL)....................... 101
( 三十) 子宮頸原位癌(Cervical Carcinoma In Situ,CIS.CIN-3.HSIL)........................... 102
( 三十一) 子宮頸原位癌(Cervical Carcinoma In Situ,CIS.CIN-3.HSIL)....................... 103
( 三十二) 子宮頸原位癌Cervical Carcinoma In Situ,CIS.CIN-3.HSIL)........................ 104
( 三十三) 子宮頸原位癌(Cervical Carcinoma In Situ,CIS.CIN-3.HSIL)....................... 105
( 三十四) 早期侵襲性鱗狀上皮癌
(Early invasive squamous cell carcinoma)................................................... 106
( 三十五) 早期侵襲性鱗狀上皮癌
(Early invasive squamous cell carcinoma)................................................... 107
( 三十六) 子宮頸鱗狀上皮癌(Cervical squamous cell carcinoma)............................. 108
( 三十七) 子宮頸鱗狀上皮癌(Cervical squamous cell carcinoma)............................. 109
( 三十八) 子宮頸鱗狀上皮癌(Cervical squamous cell carcinoma)............................. 110
( 三十九) 子宮頸鱗狀上皮癌(Cervical squamous cell carcinoma)............................. 111
( 四十) 子宮頸鱗狀上皮癌(Cervical squamous cell carcinoma).................................. 112
( 四十一) 子宮頸鱗狀上皮癌(Cervical squamous cell carcinoma)............................. 113
第三章子宮頸陰道鏡綜合臨床應用篇................................................................................ 114
第四章陰道鏡之其他所見..................................................................................................... 188
目錄
XI
第三篇子宮頸上皮內贅瘤(CIN) 之處理方法............................................... 207
( 一) 標靶切片取樣(Target biopsy)................................................................................... 207
( 二) 電花燒療法或稱為電灼療法器械(Fulguration) 與使用方法................................. 207
( 三) 冷凍手術治療器械(Cryosurgical freezer) 與使用方法.......................................... 209
( 四) 手術刀錐狀切除(Cold-knife conization).................................................................. 212
( 五) 高頻率電流(High-frequency current) 手術刀器械與使用方法......................... 213
( 六) 陰道鏡二氧化碳雷射手術治療器械(CO2 laser) 與使用方法............................... 214