宫颈癌及高级别宫颈上皮内瘤变子宫切除术后阴道上皮内瘤变88例临床分析

发布时间：2018-06-27 09:11

本文选题：阴道上皮内瘤变 + 人乳头瘤病毒　；参考：《实用妇产科杂志》2017年06期

【摘要】：目的:探讨宫颈癌及高级别宫颈上皮内瘤变(CINⅡ及以上,简称CINⅡ+)子宫切除术后阴道上皮内瘤变(VaIN)的临床特点、诊断及治疗。方法:回顾性分析收治的宫颈癌及CINⅡ+术后门诊规律随访时经阴道镜下活检发现的88例VaIN患者(VaINⅠ55例,VaINⅡ23例,VaINⅢ10例)的临床病理资料。结果:(1)88例患者中82例(93.18%)无明显临床症状。发生VaINⅠ的中位年龄(47.23岁)低于VaINⅡ+(50.75岁),差异有统计学意义(P0.05)。(2)CINⅡ+和宫颈癌术后发生VaIN的平均时间为22.01±4.13月,CINⅡ+及宫颈癌术后2年内发现VaIN的比率(65.90%)高于2年及以上(34.10%),差异有统计学意义(P0.05)。(3)TCT、HPV及两者联合筛查VaIN的敏感性分别为44.57%、69.31%、87.50%,差异有统计学意义(P0.05)。(4)HPV感染:61例HPV感染的VaIN患者中,高危型HPV感染58例(95.08%)。发生VaIN时HPV感染亚型与既往CINⅡ+或宫颈癌时HPV感染亚型相同的VaINⅡ+所占比例(56.00%)多于VaINⅠ(17.78%),差异有统计学意义(P0.05)。(5)共失访8例(9.09%)。50例VaINⅠ患者均未治疗,随访24例(48.00%)患者转为正常,23例(46.00%)患者为持续VaINⅠ状态,3例(6.00%)进展为VaINⅡ。未行治疗的VaINⅡ患者7例,规律随访6例,无一例进展;经手术治疗的VaINⅡ+患者24例,无一例进展为阴道癌。1例持续的阴道或外阴上皮的中重度不典型增生,共行4次手术治疗。结论:VaIN多无临床症状,易漏诊;随年龄的增加,VaIN的级别较高。CINⅡ+及宫颈癌术后2年内应密切监控VaIN的发生。HPV和TCT联合筛查能提高对VaIN的诊断。检测特定类型的HPV感染对于识别VaIN风险有一定重要性。VaINⅠ采用观察治疗可行,VaIN病变均应严密随访。
[Abstract]:Objective: To investigate the clinical characteristics, diagnosis and treatment of vaginal intraepithelial neoplasia (VaIN) after hysterectomy for cervical cancer and high grade cervical intraepithelial neoplasia (CIN II and above, CIN II). Methods: retrospective analysis of 88 cases of VaIN patients (55 cases of VaIN I) who were detected by colposcopy biopsy in the follow-up period after the operation of cervical cancer and CIN II + operation. The clinicopathological data of VaIN II 23 cases and VaIN III 10 cases. Results: (1) 82 cases (93.18%) had no obvious clinical symptoms in 88 patients. The median age of VaIN I (47.23 years) was lower than VaIN II + (50.75 years), the difference was statistically significant (P0.05). (2) the average time of VaIN after CIN II + and cervical cancer was 22.01 + 4.13 months, CIN II + and postoperative 2 after cervical cancer operation. The ratio of VaIN (65.90%) was higher than 2 years and above (34.10%), and the difference was statistically significant (P0.05). (3) TCT, HPV and the sensitivity of combined screening VaIN were 44.57%, 69.31%, 87.50%, respectively (P0.05). (4) HPV infection: 61 cases of HPV infection in VaIN patients, 58 cases of high-risk HPV infection (95.08%). VaIN HPV sense The proportion of VaIN II + in the subtype of HPV infection (56%) was more than that of VaIN I (17.78%), and the difference was statistically significant (P0.05). (5) 8 cases (9.09%),.50 cases, VaIN I patients were not treated, 24 cases (48%) were turned to normal, 23 (46%) patients were continuous VaIN I state, 3 cases (6%) progress. For VaIN II. 7 cases of VaIN II patients who were untreated, 6 cases were followed up regularly, no progress was made; 24 cases of VaIN II + patients treated with surgical treatment, none of them progressed to the moderate and severe atypical hyperplasia of vaginal or vulvar epithelium in.1 cases. Conclusion: VaIN had no clinical symptoms and missed diagnosis; with the increase of age, VaIN grade No higher.CIN II + and 2 years after cervical cancer should closely monitor the occurrence of VaIN.HPV and TCT combined screening to improve the diagnosis of VaIN. Detection of specific types of HPV infection is of certain importance for identifying the risk of VaIN.VaIN I is feasible with observation, and VaIN lesions should be closely followed up.
【作者单位】：中南大学湘雅二医院;
【分类号】：R737.33

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