全子宫切除术后阴道上皮内瘤样病变治疗探讨

Approach on Treatment of Vaginal Intraepithelial Neoplasia after Total Hysterectomy

阴道上皮内瘤样病变(VAIN)是指局限于女性阴道上皮的癌前病变。目前研究认为感染人乳头瘤病毒(HPV)是VAIN发生的最主要因素,持续HPV感染是VAIN疾病进展的独立危险因素,VAIN患者常同时合并宫颈上皮内瘤变(CIN),因液基薄层细胞检测(TCT)普及,筛查率提高,能对宫颈病变起到早期诊断并提高诊断率的作用。对于CIN2+抗病毒治疗及环形电极切除术(LEEP)治疗后病变持续存在或复发者,全子宫切除术成为一种治疗选择。因宫颈因素或者非宫颈因素行全子宫切除术后患者的VAIN受多种因素影响,如缺乏特异性临床症状,病灶特殊性、阴道结构的限制,术后解剖结构改变等可能导致延误诊治,且临床上尚无治疗全子宫切除术后VAIN的指南。综述全子宫切除术后VAIN的治疗进展。

Vaginal intraepithelial neoplasia（VAIN） is a line of precancerous lesions limited to the female vaginal epithelium. Current research suggests that HPV infection is the most important factor for VAIN. Continuous HPV infection is an independent risk factor for the progression of a VAIN disease. The patient is often subject to cervical intraepithelial neoplasia（CIN） concomitantly. Because of the pervasion of thin-cytologic test（TCT）, screening rate has been increased and an early diagnosis has been achieved to improve the diagnosis rate. Persistent lesion or relapse of CIN2＋ after antiviral therapy and loop electrosurgical excision procedure（LEEP）, total hysterectomy becomes a treatment option caused by cervical or non-cervical factors. In the patients after total hysterectomy VAIN due to a variety of factors, such as the lack of specific clinical symptoms,limitation of lesions particularity and structure of the vagina, postoperative anatomical changes may result in delayed diagnosis and treatment, and there has been no clinical guidelines for the treatment of VAIN after total hysterectomy so far. This article reviews the progress of treatment of VAIN after total hysterectomy.