阴道上皮内瘤变15例临床诊疗分析

Analysis of 15 patients with vaginal intraepithelial neoplasia

目的:探讨阴道上皮内瘤变(vaginal intraepithelial neoplasia,VAIN)的临床诊疗方法。方法:回顾性分析重庆市妇幼保健院妇科门诊2009年6月至2012年3月确诊的15例VAIN患者临床资料与CO2激光治疗诊疗情况。结果:患者中位年龄50岁,12例(80.00%,12/15)合并高危型人乳头瘤病毒(human papillomavirus,HPV)感染;10例(66.67%,10/15)既往因宫颈病变行子宫切除,治疗后3个月11例(73.33%,11/15)病灶完全消失;4例病变持续,再次CO2激光治疗,其中3例病灶消退,另1例1年后进展为阴道浸润性鳞癌,住院化疗。术后1年HPV转阴率达到83.33%。结论:VAIN发病年龄较大,与高危型HPV感染、宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)及宫颈癌病史密切相关;CO2激光可用于VAIN治疗,应重视术后随访,警惕病灶复发或进展为浸润癌。

Objective：To investigate the clinical diagnosis and treatment of vaginal intraepithelial neoplasia （VAIN）. Methods：Fifteen cases of VAIN diagnosed and treated in the department of cervical diseases in the Maternal and Child Health Center of Chongqing from June 2006 to March 2012 were analyzed retrospectively. Results ：The median age among all the patients were 50 years. Among 15 cases, 12 cases （80.00%, 12/15） were infected with HPV and 10 cases（66.67%, 10/15） had hysterectomy for cervical disease before. Three months after the treatment, 11 cases（73.33%, 11/15） had complete response.Four cases had focus nidus sustained and were treated by CO2 laser therapy 3 to 6 months later,with complete response in 3 cases.However,one case developed to squamous cell carcinoma of the vagina one year later and was treated in the inpatient department. One year after the treatment, the negative transformation rate of HPV was 83.33%. Conclusions：The age of onset of VAIN is elder and VAIN is related with HPV infection, cervical intraepithelial neoplasia and cervical cancer. CO2 laser therapy can be used to treat VAIN and follow-up after the treatment should be taken for the risk of relapsing or developing into infiltrating carcinoma.