阴道上皮内瘤变或癌与宫颈上皮内瘤变或癌临床特点相关性分析

Analysis of correlation between clinical characteristics of vaginal precancerous lesions or cancer and those of cervical precancerous lesions or cancer

目的探讨阴道上皮内瘤变或癌与宫颈上皮内瘤变或癌的临床特点相关性。方法回顾性分析2005年1月至2012年9月中国医科大学附属盛京医院收治的阴道上皮内瘤变(VAIN)、阴道癌合并宫颈上皮内瘤变(CIN)或宫颈癌患者36例作为观察组,同期收治的单发阴道癌患者20例(VAC组)及单发宫颈癌Ⅱa期患者30例(CC组)为对照组,进行对比分析。对全部入组患者进行术后随访。结果观察组与CC组比较,平均年龄、绝经情况、人乳头瘤病毒(HPV)阳性率及临床症状差异均无统计学意义(P>0.05);而与VAC组比较,平均年龄轻、绝经后患者少、HPV感染者多(P<0.05)。各组比较,有临床症状者差异无统计学意义,但观察组内,合并宫颈癌(10/12)或阴道癌(5/6)组多有症状,而CIN+VAIN组有症状者较少(10/18)。随访病例进行生存分析显示,观察组病例平均生存时间为(40.42±4.74)个月[其中CC+VAIN为(43.97±5.05)个月,CIN+VAC为(27.50±1.75)个月],VAC组平均生存时间为(32.00±5.22)个月,CC组平均生存时间为(38.18±1.24)个月。结论高危型HPV感染是阴道病变与宫颈病变的共同致病因素,而HPV感染导致的阴道病变的临床特点与单纯宫颈病变更相似。阴道癌除了与HPV感染相关外,其他致病因素也不容忽视。

Objective To explore the relevance of clinical characteristics between vaginal precancerous lesions or cancer and cervical precancerous lesions or cancer.Methods A retrospective analysis was made on the clinical data of 36 patients who underwent VAIN, with vaginal cancer complicated with the cervical lesions or cervical cancer from Jan. 2005 to Sep. 2012 in Shengjing Hospital （the obervation group）. Twenty cases of vaginal cancer patients and 30 cases of cervical cancer patients were included as the control froup. Compare the data of the two groups.Follow up all the patients. Results Comparing the observation group with control group, the average age, menopausal status, HPV infection and clinical symptoms were of no difference between the two groups （P〉O.05） ; but compared with the vaginal cancer group, the observation group had lower average age, fewer patients of menopausal status, and more patients with HPV infection. There were no significant differences of clinical symptoms among the groups, but in observation group, most patients （ 10 of 12 in the group with cervical cancer and 5 of 6 in the group with vaginal cancer ） had clinical symptoms, but in group CIN＋VAIN, the rate was decreased （10 of 18）. Survival analysis showed that the mean survival time of observation group was 40.42±4.74m[CC＋VAIN group ： （43.97±5.05）m; CIN＋VAC：（27.50±1.75）m], and in VAC group it was （32.00±5.22） m, CC group （38.18±1.24）m.Conelusion The high-risk HPV infection is the common risk factor of cervical lesions and vaginal lesions .The clinical characteristics of vaginal lesions caused by HPV infection are similar to those of the single cervical lesion. Vaginal cancer also has association with other pathogenic factors besides HPV infection.