子宫颈切除术后出现阴道高级别鳞状上皮病变患者的临床资料分析

An analysis of clinical data of patients with vaginal high-grade squamous intraepithelial lesions after cervical resection

目的探讨子宫颈切除术后阴道高级别鳞状上皮病变(VaHSIL)患者的临床特点。方法回顾性分析2016—2018年子宫颈切除术后体检或随访结果出现HPV阳性、阴道脱落细胞学检测异常和经阴道镜活检发现的VaHSIL患者的临床资料。结果3年总计5606例宫颈高级别上皮病变(HSIL)患者实施阴道镜下手术,经阴道镜发现VaHSIL 553例(单纯VaHSIL 161例,VaHSIL合并宫颈HSIL 378例,VaHSIL合并宫颈癌14例)。其中,腹腔镜下全子宫切除术后出现VaHSIL组(A组)131例,年龄(52.30±9.56)岁,经腹全子宫切除术后出现VaHSIL组(B组)69例,年龄(56.09±9.66)岁。A组出现VaHSIL时间为术后(2.23±1.72)年,早于B组的(5.37±3.01)年(P<0.01)。患者前期宫颈HSIL及宫颈癌患病与VaHSIL发生密切相关(P<0.01)。结论VaHSIL与前期宫颈HSIL和宫颈癌患病有关;腹腔镜下全子宫切除术后VaHSIL的风险高于经腹全子宫切除术。

Objective To analyze the clinical characteristics of the patients with vaginal high-grade squamous intraepithelial lesions(VaHSIL)after cervical resection.Methods The clinical data of VaHSIL patients with HPV-positive results detected by physical examination,abnormal cytology of vaginal exfoliation or colposcopic biopsy after cervical resection in the years of 2016 to 2018 were analyzed retrospectively.Results A total of 5606 cases underwent colposcopy in the over past three years,VaHSIL was diagnosed in 553 cases(simple VaHSIL 161 cases,VaHSIL with cervical HSIL 378 cases,VaHSIL with cervical cancer 14 cases).Of 553 cases with VaHSIL,laparoscopic hysterectomy was performed before in 131 cases aged(52.30±9.56)years old(group A)and transabdominal hysterectomy was performed before in 69 cases aged(56.09±9.66)years old(group B).The time of VaHSIL diagnosis after original surgery was earlier in group A than that in group B[(2.23±1.72)years vs.(5.37±3.01)years](P<0.01).Prophase cervical HSIL and cervical cancer were closely to VaHSIL occurrence(P<0.01).Conclusion Prophase cervical HSIL and cervical cancer are closely related to VaHSIL occurrence.The risk for VaHSIL occurrence after laparoscopic hysterectomy is higher than that after transabdominal hysterectomy.