宫颈病变子宫切除术后阴道上皮内瘤变的筛查及其临床意义

Screening Method its Clinical Significance of Vaginal Intraepithelial Neoplasia （VAIN） after Hysterectomy for Cervical Lesions

【目的】探讨因宫颈病变行子宫切除术后阴道上皮内瘤样变（VAIN）筛查方法及其临床意义。【方法】回顾性分析2009年1月1日至2012年12月31日在中南大学湘雅附二医院因宫颈病变行子宫切除术后在随诊中确诊为VAIN的28例患者的临床资料及随诊过程中液基细胞学（TCT）、人乳头状病毒（HPV）感染和症状学的相关资料。【结果】28例患者中在术后2年和5年内诊断为VAIN分别占78．57%（22/28）和96．43%（27/28）。液基细胞学检测（TCT）结果为：高度上皮内瘤变（SHIL）2例，低度上皮内瘤变（LSIL）2例，非典型鳞状上皮细胞（ASCUS）为14例，占50%；未见上皮内瘤变及恶变10例占35．75%。高危HPV感染阳性率为92．86%（26/28），以HPV16和HPV52为主，各4例。有阴道症状患者为12例（42．86%），无症状16例占57．14%。【结论】因宫颈病变行子宫切除术后患者的高危HPV感染阳性率比TCT筛查的VAIN阳性率更高，但特异性差。因此，对此类患者的术后VAIN筛查应结合TCT、高危HPV-DNA分型及临床症状综合分析，避免漏诊。

[Objective] To investigate the screening method of vaginal intraepithelial neoplasia （VAIN） after hysterectomy for cervical lesions and its clinical significance.[Methods]From January 1, 2009 to December 31, 2012, the clinical data of 28 patients diagnosed as VAIN after hysterectomy in our hospital due to cervical lesions were retrospectively analyzed, and the data of Thin-Prep Cytology Test （TCT）, human papillomavirus （HPV） infection and symptomatology were also reviewed retrospectively.[Results] 28 patients were diagnosed as VAIN within 2 and 5 years after operation, accounting for 78.57% （22/28） and 96.43% （27/28） respectively. The results of Thin-Prep Cytology Test （TCT） （TCT） were： high intraepithelial neoplasia （SHIL） in 2 cases, low-grade intraepithelial neoplasia （LSIL） in 2 cases, atypical squamous epithelial cell （ASCUS） in 14 cases, accounting for 50% there were no intraepithelial neoplasia and malignant transformation in 10 cases, accounting for 35.75%. The positive rate of high risk HPV infection was 92.86% （26/28）, mainly HPV16 and HPV52, with 4 cases in each group. There were 12 cases with vaginal symptoms （42.86%）, 16 cases without symptoms, accounting for 57.14%.[Conclusion]The positive rate of high risk HPV infection in patients with cervical lesions after hysterectomy is higher than that of TCT screening VAIN, but the specificity is poor. Therefore, the postoperative VAIN screening should be combined with TCT, high-risk HPV-DNA typing and comprehensive analysis of clinical symptoms, so as to avoid missed diagnosis.