外阴尖锐湿疣合并宫颈病变175例分析

Analysis of cervical lesions in 175 patients with condyloma acuminatum of vulva

目的 了解外阴尖锐湿疣 (CA)患者合并宫颈病变的情况。方法 经病理确诊的 175例外阴CA患者在阴道镜下取宫颈组织活检 ,其中 15 2例应用PCR或免疫组化技术做HPV11 6、18 16分型检测 ;用同期无外阴CA的 10 0例宫颈病理作对照。结果 宫颈CA15例 ,占病理诊断宫颈HPV感染 81例的 18.5 % ;外阴CA患者合并宫颈HPV亚临床感染 (SPI)和 (或 )宫颈上皮内瘤变 (CIN)占 5 4 9% ,明显高于对照组的 13 0 % (P <0 0 0 1) ;宫颈CA及SPI中CIN发生率为 5 0 6 2 % ,明显高于宫颈慢性炎症及疣样病变的CIN发生率 (P <0 0 5 ) ;宫颈光滑组中SPI、CIN、慢性炎症及疣样病变等宫颈病变的发生率较宫颈糜烂组无明显差异 ;HPV18 16型感染组宫颈CA、SPI和 (或 )CIN的发生率明显高于HPV11 6型感染组 (P <0 0 1)。结论 对女性生殖道HPV感染在治疗外在湿疣的同时 ,更应重视宫颈亚临床感染 ,应借助阴道镜、组织病理及分子生物学相关技术早期发现SPI及CIN ,早期治疗。

Objective To analyze cervical lesions in patients with condyloma acuminatum (CA) of vulva.Methods 175 patients with CA diagnosed by pathology were performed cervical biopsy under vaginoscope.Among them,152 patients were tested HPV 11/6 ?18/16 types by immunohistochemistry or PCR.The control group consisted of the uterine cervices from 100 patients without vulvar CA in the same period. Results 18 5% patients with cervical HPV infection had CA of cervix . The rate of patient complicated with SPI and/or CIN was significantly higher than that of control(54 9% vs 13 0% , P<0 001). The incidence of CIN in the patients with cervical CA and SPI was higher than that of no HPV infection(50 62% vs 32 98% , P<0 05). The incidence of different cervical lesions between patients with smooth cervix and cervical erosion was not significantly different. The incidence of CA in cervix?SPI and/or CIN in the patients with cervical HPV 18/16 type infection was higher than that in HPV11/6 infection(83 87% vs 55 43%, P<0 01). Conclusion We should not only treat the CA in vulva and cervix of female reproductive tract infected by HPV, but also pay more attention to the cervical SPI and/or CIN. Vaginoscope,histopathology and some molecule biology techniques would be helpful for early diagnosis .