50例阴道上皮内瘤变临床治疗分析

Analysis of clinical treatment of 50 cases of vaginal intraepithelial neoplasia

目的 探讨阴道上皮内瘤变（VAIN）的临床特征及治疗方法。方法 回顾分析50例VAIN患者的临床资料,其中VAINⅠ、Ⅱ、Ⅲ级分别为16、5、29例,年龄33~76岁。结果 多数患者无临床症状,少数表现为阴道分泌物增多,82%患者病变位于阴道穹窿或上1/3,18%位于阴道中、下1/3,VAINⅠ级患者观察随访,VAIN Ⅱ级患者阴道局部用药,VAIN Ⅲ级患者行三维高剂量率腔内后装放疗。HPV感染与VAIN级别呈正相关（P=0.028）。结论 VAIN级别与高危型HPV感染呈正相关,腔内后装放疗对VAIN Ⅲ级患者起到有效治疗作用,副反应小治愈率高。

Objective To investigate the clinical features and treatment of vaginal intraepithelial neoplasia （VAIN）. Methods Clinical data of 50 patients with VAIN, aged 33-76 years, were retrospectively analyzed. Among them, 16 patients were diagnosed with grade Ⅰ VAIN, 5 with grade Ⅱ VAIN and 29 with grade Ⅲ VAIN. Results A majority of VAIN patients presented with no clinical symptoms, whereas few cases were manifested with increased vaginal secretion. The lesions were located in the vaginal fornix or the upper 1/3 of the vagina in 82% of patients, and in the middle and lower 1/3 of the vagina in the remaining 18% cases. Patients with VAIN Ⅰ were observed during follow-up, VAIN Ⅱ patients were given with local administration of medication, and VAIN Ⅲ patients received three-dimensional high-dose rate after loading intracavitary radiotherapy. Human papilloma virus （HPV） infection was positively correlated with VAIN grade （P=0.028）. Conclusions The VAIN grade is positively correlated with high-risk HPV infection. Afterloading intracavitary radiotherapy is an efficacious therapeutic approach for VAIN Ⅲ patients,which yields slight adverse events and high cure rate.