宫颈疾病行手术治疗后继发阴道上皮内肿瘤的临床特征及结局分析

Clinical features and outcome analysis of vaginal intraepithelial neoplasia secondary to cervical diseases after surgical treatment

目的探讨因宫颈疾病行手术治疗后继发阴道上皮内肿瘤(Vaginal intraepithelial neoplasia,VAIN)的临床特征及相关风险因素。方法选取2010年1月~2018年12月间因宫颈疾病行手术治疗后继发VAIN的患者共35例,分析VAIN的发生与患者年龄、宫颈病变严重程度、宫颈锥切术后切缘情况、子宫切除术后HPV感染情况及TCT结果的相关性,并观察VAIN的发生时间及预后结局。结果随着宫颈疾病严重程度的升高,VAIN的发生率明显升高,且VAINⅡ~Ⅲ级患者既往宫颈病变的严重程度高于VAINⅠ级患者,差异有统计学意义(P=0.017)。VAIN患者人乳头瘤病毒(Human papillomavirus,HPV)感染发生率为100.0%,其中高危型HPV感染率为88.6%;且VAINⅡ~Ⅲ级患者的高危型HPV感染率略高于VAINⅠ级患者的高危型HPV感染率,但差异无统计学意义(P=0.082)。VAIN大多发生在子宫切除术后5年内,占80%;VAINⅠ级患者治疗后有4例持续存在,其中1例进展为VAINⅡ~Ⅲ级;VAINⅡ~Ⅲ级患者治疗后有5例复发,其中2例进展为阴道鳞状上皮癌,复发及进展患者均存在高危型HPV持续感染。结论宫颈疾病行子宫切除术后继发VAIN的发病与HPV感染及宫颈病变程度密切相关,对存在以上因素的患者在行子宫切除术时应予以重视,建议术前阴道壁组织活检术明确,以切除病变阴道壁组织减少VAIN的发生,术后需密切随访监测以早期发现阴道病变并及时治疗。

Objective To explore the clinical features and related risk factors of vaginal intraepithelial neoplasia(VAIN)secondary to cervical diseases after surgical treatment.Methods A total of 35 patients with VAIN secondary to cervical diseases after surgical were collected.The correlation between VAIN occurrence and patients′age,severity of cervical lesions,cutting edge after cervical conization,Human papillomavirus(HPV)infection after hysterectomy and TCT results were analyzed,and the occurrence time and prognosis of VAIN were observed.Results With the increase of the severity of cervical diseases,the incidence of VAIN increased significantly,and the severity of previous cervical lesions in VAIN gradeⅡ-Ⅲpatients was higher than that in VAIN grade I patients,with statistically significant difference(P=0.017).The incidence of HPV infection in VAIN patients was 100%,in which the infection rate of high-risk HPV was 88.6%.Furthermore,the high-risk HPV infection rate of VAIN gradeⅡ-Ⅲpatients was slightly higher than that of VAIN grade I patients,but the difference was not statistically significant(P=0.082).VAIN mostly occurred within 5 years after hysterectomy,accounting for 80%.After treatment,4 patients with VAIN grade I persisted,and 1 patient progressed to VAIN gradeⅡ-Ⅲ.After treatment,5 patients with VAIN gradeⅡ-Ⅲrelapsed,among which 2 patients advanced to vaginal squamous cell carcinoma.Both relapsed and advanced patients had high-risk HPV persistent infection.Conclusion The incidence of VAIN secondary to cervical diseases after hysterectomy is closely related to HPV infection and the degree of cervical lesions.Attention should be paid to patients with the above factors when undergoing hysterectomy.It is suggested that biopsy of vaginal wall should be clear before operation so as to cut off the diseased vaginal wall tissue and reduce the occurrence of VAIN.Close follow-up monitoring after surgery is needed to find vaginal lesions early and treat them in time.