阴道上皮内瘤变89例回顾性研究

Retrospective study on 89 cases of vaginal intraepithelial neoplasia

目的探讨阴道上皮内瘤变(VAIN)的临床特征、相关危险因素及治疗方案。方法整理2013年7月至2015年4月在重庆医科大学附属第一医院病理学检查确诊的89例VAIN患者的病历资料,其中VAINⅠ26例,VAINⅡ27例,VAINⅢ36例。回顾性分析VAIN的发病高危因素、临床特征及治疗方案。结果 63例患者进行了新柏氏液基细胞学检测,结果异常46例(73. 02%),其中非典型鳞状上皮细胞24例,低度鳞状上皮内瘤变11例,高度鳞状上皮内瘤变11例。66例患者进行了人乳头瘤病毒(HPV)检测,高危型HPV阳性57例(86. 36%)。89例患者中既往或同时合并宫颈疾病70例(78. 65%),其中宫颈上皮内瘤变1(CIN1) 7例,CIN2 12例,CIN3 26例,宫颈癌25例。89例患者中合并宫颈癌18例(术后失访排除1例),手术治疗同时治愈13例(76. 47%);接受同步放、化疗3例,随访中病情未进展;局部应用干扰素后治愈1例。71例无癌患者中(随访中断排除4例)给予个体化治疗30例,治愈率为70. 00%(21/30),其中手术治愈率为87. 50%(7/8),电灼治愈率为77. 78%(7/9);给予干扰素局部应用37例,治愈率为37. 84%(14/37)。结论宫颈癌及CIN是VAIN发生的重要因素,宫颈病变时需警惕阴道病变的存在,给予残端阴道规律筛检。宫颈癌筛检模式适于VAIN,筛检异常必要时应转诊阴道镜以全面评估阴道。VAIN治疗需个体化,手术和电灼治愈率高。

Objective To investigate the clinical features,related risk factors and treatment schemes of vaginal intraepithelial neoplasia(VAIN).Methods The medical records of 89 cases of VAIN confirmed by pathology in the First Affiliated Hospital of Chongqing Medical University from July 2013 to April 2015 were reviewed,including 26 cases of VAINⅠ,27 cases of VAINⅡand 36 cases of VAINⅢ.The onset high risk factors,clinical features and treatment schemes of VAIN were retrospectively analyzed.Results Sixty-three cases conducted ultrathin liquid based cytology smear(TCT)examination,46 cases(73.02%)had abnormal results,including 24 cases of atypical squamous epithelial cells(ASC),11 cases of low-grade squamous intraepithelial neoplasia(LSIL)and 11 cases of highly squamous intraepithelial neoplasia(HSIL).Sixty-six cases underwent the HPV detection,57 cases(86.36%)were the high risk type of HPV positive.Among 89 cases,70 cases(78.65%)had past or simultaneously complicating cervical disease,including CIN1 in 7 cases,CIN2 in 12 cases,CIN3 in 26 cases and cervical cancer in 25 cases.Among 89 cases,18 cases were complicating cervical cancer(excluding 1 case due to lose postoperative follow up),13 cases(76.47%)were treated by operation and cured;3 cases received the concurrent chemoradiotherapy,the disease condition had no progression;1 case was cured after local use of interferon.Among 71 cases without cancer(excluding 4 cases due to follow up interruption),30 cases were given individualized treatment with the cure rate of 70.00%(21/30),in which operative cure rate was 87.50%(7/8),the electrocauterization cure rate was 77.78%(7/9);37 cases were given the local treatment of interferon with the cure rate of 37.84%(14/37).Conclusion Cervical cancer and CIN are the important factors for the occurrence of VAIN.The presence of vaginal lesions in cervical lesions should be vigilant,which should be given the regular screening of residual vagina.The cervical cancer screening model is suitable for VAIN,the screening abnormalities,if necessary,should be converse to colposcopy for a complete evaluation of the vagina.The treatment of VAIN should be individualized,surgery and electrocauterization have high cure rate.