不同方法治疗阴道上皮内瘤变Ⅱ级合并高危HPV感染的临床疗效分析

Analysis of the clinical effectiveness of different methods of treating gradeⅡvaginal intraepithelial neoplasia and a high-risk HPV infection

目的探讨不同治疗方法对阴道上皮内瘤变Ⅱ级合并高危HPV感染的临床疗效。方法选择2017年3月-2020年7月本院收治的阴道上皮内瘤变(VAIN)Ⅱ级合并高危HPV感染患者300例,随机分为YAG激光治疗组、光动力治疗组和咪喹莫特治疗组,每组100例。于治疗前和治疗后第3、6、12个月各随访1次,记录妇科检查、阴道镜检查、阴道液基细胞学检查、HPV-DNA分型定量检查情况,比较治疗次数、治愈率、复发率、不良反应等。结果实际完成治疗及随访者共251人,其中YAG组100人,光动力组86人,咪喹莫特组65人。治疗次数中位数分别为:YAG激光治疗组1次,光动力治疗组4次,咪喹莫特治疗组48次。治愈率分别为:YAG激光治疗组84.0%、光动力治疗组59.3%、咪喹莫特治疗组76.9%。YAG激光治疗组与咪奎莫特治疗组比较差异无统计学意义(P=0.212),但这两组与光动力组比较差异有统计学意义,且疗效均优于光动力组(P≤0.01)。随访过程中所有患者病情均无进展,复发率分别为:YAG激光治疗组9.0%,光动力治疗组19.8%,咪喹莫特治疗组10.8%,差异无统计学意义P>0.05)。不良反应发生率YAG激光治疗组30.0%,光动力治疗组26.7%,咪喹莫特治疗组56.9%,差异有统计学意义(P<0.05);YAG激光治疗组与光动力治疗组比较不良反应发生率差异无统计学意义(P>0.05)。结论YAG激光和咪喹莫特治疗VAINII伴高危型HPV感染均有良好疗效。

Objective To investigate the clinical effectiveness of different methods of treating gradeⅡvaginal intraepithelial neoplasia(VAINⅡ)and a high-risk HPV infection.Methods Subjects were a total of 300 patients who were diagnosed with VAINII and a high-risk HPV infection and who underwent treatment at this Hospital from March 2017 to July 2020.Patients were randomly divided into a group treated with a YAG laser,a group treated with photodynamic therapy,and a group treated with 5%imiquimod cream.There were 100 patients in each group.Patients were followed up once before treatment and 3,6,and 12 months after treatment.Results of a gynecological examination,ThinPrep cytology,and human papillomavirus(HPV)typing were recorded,and the number of treatments,the cure rate,the rate of recurrence,and adverse reactions were compared.Results A total of 251 patients completed the treatment and were interviewed,including 100 in the YAG group,86 in the photodynamic therapy group,and 65 in the imiquimod group.The cure rate in the three groups was 84.0%in the YAG laser treatment group,59.3%in the photodynamic therapy group,and 76.9%in the imiquimod group.There were no significant differences in the cure rate between the YAG laser treatment group and the imiquimod group(P=0.212),but the cure rate differed significantly in the two groups compared to that in the photodynamic therapy group(P<0.01).Treatment was more effective than that in the photodynamic therapy group.During follow-up,there was no disease progression in any of the patients,and the rate of recurrence was 9%in the YAG laser treatment group,19.8%in the photodynamic therapy group,and 10.8%in the imiquimod group.The rate of recurrence did not differ significantly among the three groups(P>0.05).The incidence of adverse reactions was 30%in the YAG laser treatment group,26.7%in the photodynamic therapy group,and 56.9%in the imiquimod group.The incidence of adverse reactions in the imiquimod group was higher than that in the other two groups(the difference was significant)but the incidence of adverse reactions did not differ significantly in the other two groups.Conclusion Both YAG laser treatment and imiquimod were effective in patients with VAINII and a high-risk HPV infection.