阴道上皮内病变555例临床分析

发布时间：2018-05-08 02:41

本文选题：阴道上皮内病变 + 临床特点　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:探讨分析近年来阴道上皮内病变患者的临床特点与诊治方式。资料与方法:回顾性收集2007年1月至2016年12月浙江大学医学院附属妇产科医院住院收治的555例阴道上皮内病变患者的临床资料,最终诊断由活检组织病理学检查及术后组织病理学检查中级别最高的组织学诊断而定,对患者的一般情况、临床症状、体征、辅助检查、诊断及治疗方式等情况进行分析。统计方法采用SP5S 20.0软件,使用t检验、Kruskal-Wallis检验和χ2检验进行统计学分析。结果:(1)555例阴道上皮内病变患者年龄为16-78岁,中位数年龄为53.00岁。(2)555例患者最终诊断为低级别阴道上皮内病变(阴道LSIL)192例(34.59%),高级别阴道上皮内病变(阴道HSIL)360例(64.86%),阴道癌3例(0.54%)。(3)555例患者中,无临床症状者340人(61.26%),首要临床症状为异常阴道流血者134人(24.14%),阴道分泌物异常27人(4.86%);妇科检查有异常发现者343人(61.80%),其中阴道异常121人(35.28%),阴道病变位于阴道穹窿或阴道残端处71人(58.68%),阴道病变位于阴道上1/3处患者13人(10.74%)。(4)病例资料中有HPV检测结果记录者477人,其中HPV阳性450人(94.34%),阴道LSIL及≥阴道HSIL两组之间高危型HPV阳性率无显著性差异(χ2=0.018,P=0.892)。HC-Ⅱ及Cervista检测结果对≥阴道HSIL病变的诊断灵敏度分别为92.57%、95.24%,特异度均低。(5)病例资料中有TCT检查结果记录者502人,阴道LSIL组患者TCT检查结果主要为LSIL(30.86%),其次为ASC-US(28.57%);阴道HSIL组患者TCT检查结果主要为HSIL(31.48%),其次为LSIL(19.44%)。阴道LSIL及≥阴道HSIL两组之间TCT检查结果无显著性差异(χ2=1.086,P=0.297)。TCT检查对≥阴道HSIL病变的诊断灵敏度为86.85%,特异度为16.57%,阳性预测值为66.05%,阴性预测值为40.28%。(6)病例资料中有阴道镜检查结果记录者548人,阴道LSIL、阴道HSIL及阴道癌三组患者的阴道镜检查诊断不足率分别为73.54%、78.93%、100%,三组之间阴道镜检查结果具有显著性差异(P=40.128,P=0.000)。(7)阴道LSIL、阴道HSIL、阴道癌三组患者合并宫颈病变例数及比例分别为134例(69.79%)、262例(72.78%)、3例(100.00%),三组之间无显著性差异(χ2=1.922,P=0.750)。555例阴道上皮内病变患者中,13例患者(2.34%)合并外阴病变。(8)555例阴道上皮内病变患者中,371例患者(66.85%)采用手术治疗,148例患者(26.67%)采用非手术治疗,34例患者(6.13%)采用随访观察。阴道LSIL组、阴道HSIL组、阴道癌组患者手术治疗率分别为51.56%、74.72%、100.00%,三组之间手术治疗率具有显著性差异(χ2=36.199,P=0.000)。在371例接受手术治疗的患者中,阴道LSIL、阴道HSIL及阴道癌三组患者术后组织病理学检查结果较术前活检组织病理学检查结果升级率分别为28.28%、29.74%、100.00%,三组之间具有显著性差异(χ2=14.748,P=0.005)。结论:(1)阴道上皮内病变多数无特殊临床症状,常并存宫颈病变,应重视对宫颈病变患者行阴道检查。(2)高危型HPV检测及阴道脱落细胞学检查对辅助诊断阴道上皮内病变有一定的临床价值。(3)阴道镜检查对诊断阴道上皮内病变的准确性较差,应对可疑病变者及时行活检组织病理学检查。(4)手术是高级别阴道上皮内病变患者的主要治疗方式。
[Abstract]:Objective: To explore the clinical features and methods of diagnosis and treatment of the patients with intraepithelial lesion of vagina in recent years. Data and methods: the clinical data of 555 cases of vaginal intraepithelial lesions admitted in the hospital affiliated to the Department of Obstetrics and Gynecology, Zhejiang University Medical College from January 2007 to December 2016 were collected, and the final diagnosis was made by biopsy histopathological examination and operation. The highest level of histology in the post histopathological examination was determined, and the general situation, clinical symptoms, signs, auxiliary examination, diagnosis and treatment were analyzed. The statistical method was SP5S 20 software, t test, Kruskal-Wallis test and chi 2 test were used for statistical analysis. Results: (1) 555 cases of vaginal epithelium The age of the patients was 16-78 years and the median age was 53 years. (2) 555 patients were finally diagnosed as low grade vaginal intraepithelial lesion (vaginal LSIL) in 192 (34.59%), high grade vaginal intraepithelial lesion (vaginal HSIL) in 360 cases (64.86%), 3 (0.54%) of vaginal carcinoma (0.54%). (3) no clinical symptom 340 (61.26%), the primary clinical symptoms were different. 134 people (24.14%) with abnormal vaginal bleeding, 27 (4.86%) with abnormal vaginal discharge, 343 (61.80%) with abnormal gynecologic examination, 121 (35.28%) of vagina abnormality, 71 in vaginal dome or vaginal stump (58.68%), and 13 (10.74%) in the vagina at 1/3. (4) cases with HPV test results There were 477 people, of which 450 were HPV positive (94.34%), and there was no significant difference in the positive rate of high risk HPV between groups of vaginal LSIL and HSIL two (P=0.892).HC- II and Cervista detection results were 92.57%, 95.24% and low specificity, respectively. (5) 502 of the case data were recorded by TCT. The results of TCT examination in the vaginal LSIL group were mainly LSIL (30.86%), followed by ASC-US (28.57%), and the results of TCT in the HSIL group of the vagina were mainly HSIL (31.48%), followed by LSIL (19.44%). There was no significant difference between the vaginal LSIL and the TCT vaginal HSIL two groups. For 86.85%, the specificity was 16.57%, the positive predictive value was 66.05%, the negative predictive value was 40.28%. (6) with the colposcopy record 548, the vagina LSIL, the vaginal HSIL and the vaginal carcinoma three groups were 73.54%, 78.93%, 100%, respectively (P =40.128, P=0.000). (7) the number and proportion of vaginal LSIL, vaginal HSIL, vaginal cancer combined with cervical lesions were 134 cases (69.79%), 262 cases (72.78%), 3 cases (100%), there was no significant difference between the three groups (chi square 2=1.922, P=0.750) in.555 cases of vaginal intraepithelial lesions, 13 patients (2.34%) with vulvar lesions. (8) 555 cases of vaginal epithelium. Of the patients, 371 patients (66.85%) were treated with surgical treatment, 148 patients (26.67%) were treated with non operative treatment and 34 patients (6.13%) were followed up. The surgical treatment rate of vaginal LSIL group, vaginal HSIL group, and vaginal cancer group was 51.56%, 74.72%, 100%, respectively (x 2=36.199, P=0.000). In 3, the rate of surgical treatment was significantly different (x 2=36.199, P=0.000). Among the 71 patients receiving surgical treatment, the postoperative histopathological examination results of vaginal LSIL, vaginal HSIL and vaginal carcinoma were 28.28%, 29.74%, 100%, respectively, compared with the preoperative biopsy histopathological examination (x 2=14.748, P=0.005). Conclusion: (1) most of the intraepithelial lesions of the vagina have no special presence. The symptoms of the cervix often coexist with cervical lesions, and should pay attention to the vaginal examination of the patients with cervical lesions. (2) high risk HPV detection and vaginal exfoliative cytology have certain clinical value for the auxiliary diagnosis of vaginal intraepithelial lesion. (3) the accuracy of the colposcopy for the diagnosis of vaginal intraepithelial lesions is poor, and the biopsy tissue should be done in time for those who are suspicious of the disease. Pathological examination. (4) surgery is the main treatment for patients with high-grade vaginal intraepithelial lesions.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.34

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