外阴和阴道上皮内瘤变的临床初步研究

Preliminary study of vulvar and vaginal intraepithelial neoplasias

目的:探讨外阴和阴道上皮内瘤变(vulvar intraepithelial neoplasias,VIN,and vaginal intraepithelial neopla-sias,VAIN)的发病特点。方法:对2004年9月至2007年12月在北京大学第三医院阴道镜门诊行外阴或阴道活检的148例女性患者进行回顾性分析。结果:148例中经病理诊断为VIN2,3或VAIN2,3级23例,VIN1或VAIN1级16例,外阴或阴道湿疣61例,以及外阴癌1例,外阴或阴道炎症47例。VIN或VAIN患者中85%(33/39)年龄在30岁以上,并且高于宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)患者的年龄。VIN,VAIN及湿疣的高危型人乳头瘤病毒(human papillomavirus,HPV)DNA检测结果阳性率达84%(84/100),其中23例VIN 2,3或VAIN2,3患者的高危型HPV DNA检测结果均为阳性。超过90%(69/75)的VAIN病灶位置在阴道上段。VIN或VAIN常与CIN或宫颈癌伴随存在或继其后发生(79%,31/39),并且高级别的VIN或VAIN常合并高级别的CIN或宫颈癌(70%,16/23)。结论:高危型HPV感染也是VIN或VAIN及癌的主要致病因素,对宫颈病变或宫颈癌患者应仔细检查外阴和阴道黏膜。

Objective：To detect the clinical features of vulvar and vaginal intraepithelial neoplasias （VIN and VAIN, respectively）. Methods： Total 148 women were performed vulvar or vaginal coloposcopy-directed biopsy pathology tests, from Sep. 2004 to Dec. 2007. Results：Among 148 women, vulvar or vaginal histologic results were vulvar cancer for 1, VIN or VAIN 2,3 for 23, VIN or VAIN for 16, condyloma for 61, vulvitis and vaginitis for 47. Eighty-five percent （33/39） women with VIN or VAIN 2,3 were more than 30 years old. Compared to women with cervical intraepithelial neoplasia （CIN） , women with VIN or VAIN were older. The rate of high-risk HPV DNA in women with vulvar or vaginal lesions was 84% （84/100）. VAIN occurred mainly in the upper vagina （90% , 69/75）. VIN or VAIN often accompanied or followed CIN or cervical cancer （79% , 31/39） , and VIN or VAIN 2,3 often accompanied or followed CIN 2,3 or cervical cancer （70%, 16/23）. Conclusion：Our data suggest that women with high-risk HPV infection are at risk of developing VIN or VAIN 2,3. The vulva and vagina should be carefully inspected by colposcopic examination at the time of colposcopy for any abnormal findings.