外阴高级别及低级别鳞状上皮内病变的临床诊断分析

The Clinical Analysis of High and Low Grode Vulvar Squamous Intraepithelial Lesion

目的:研究和比较外阴高级别及低级别鳞状上皮内病变(SIL)的临床特点。方法:对2016年1月至2018年12月在复旦大学附属妇产科医院SIL患者119例的临床资料进行回顾性分析,其中外阴低级别鳞状上皮内病变(LSIL)88例,外阴高级别鳞状上皮内病变(HSIL)31例。结果:①临床症状方面,外阴无症状占63.9%(76/119),外阴LSIL和HSIL无症状的比例差异无统计学意义(64.8%vs 61.3%,P>0.05)。②细胞学异常[意义不明确的不典型鳞状细胞(ASC-US)、LSIL、HSIL]比例为42.9%(51/119)。人乳头瘤病毒(HPV)阳性率占89.1%(106/119)。外阴LSIL和HSIL在细胞学异常和HPV阳性比例方面比较,差异均无统计学意义(39.8%vs 51.6%;88.6%vs 90.3%,P>0.05)。③外阴LSIL和HSIL病灶存在色素沉着比例比较,差异有统计学意义(13.6%vs 58.1%,P<0.05),在多灶性分布方面差异无统计学意义(35.2%vs 35.5%,P>0.05)。④外阴LSIL与外阴HSIL在阴唇后联合及舟状窝部位的活检比例比较,差异有统计学意义(67.8%vs 43.9%,P<0.05)。⑤外阴SIL患者伴随多中心病灶达36.1%(43/119),外阴LSIL与外阴HSIL合并多中心情况比较,差异无统计学意义(P>0.05)。结论:外阴SIL与HPV感染密切相关,存在色素沉着是外阴HSIL与外阴LSIL相区别的重要特征。在下生殖道检查中,应避免漏诊外阴SIL。

Objective:To investigate the clinical features of low and high grade vulvar squamous intraepithelial lesion.Methods:The data of 119 vulvar squamous intraepithelial lesion patients LSIL 88 cases,HSIL 31 cases collected from January 2016 to December 2018 in Obstetrics and Gynecology Hospital of Fudan University,were analyzed retrospectively.Results:①76 cases were asymptomatic in vular,which accounted for 63.9%(76/119).There was no statistical difference in clinical symptoms of vulvar lesion between LSIL and HSIL(64.8%vs.61.3%,P>0.05).②The rate of abnormal cytology(ASCUS,LSIL,HSIL)was 42.9%(51/119).The positive rate of HPV test in patients was 89.1%(106/119).There was no significant difference in cytology and HPV test of vulvar lesion between LSIL and HSIL(39.8%vs.51.6%,88.6%vs.90.3%,P>0.05).③There was a significant difference in pigmentation of vulvar lesion between LSIL and HSIL(13.6%vs.58.1%,P<0.05),while no statistical difference in multifocal distribution of lesions between them(35.2%vs.35.5%,P>0.05).④There was a significant difference in punch biopsy locations being frenulum labium pudendal and fossa navicular between vulvar LSIL and HSIL(67.8%vs.43.9%,P<0.05).⑤The total rate of vulvar squamous intraepithelial lesion accompanied with multi-center lesion(cervix,vagina)was 36.1%(43/119),there was no significant difference in vulvar lesion accompanied with multi-center lesion between LSIL and HSIL(P>0.05).Conclusions:HPV is closely associated with vulvar squamous intraepithelial lesion,the difference between low and high grade vulvar squamous intraepithelial lesion is pigmentation.We should avoid missing vulvar squamous intraepithelial lesion during lower genital examinations.