子宫切除术后阴道上皮内瘤变80例临床分析

Clinical analysis of 80 cases of vaginal intraepithelial neoplasia after hysterectomy

目的探讨子宫切除术后阴道上皮内瘤变(vaginal intraepithelial neoplasdia,VaIN)的临床特征、诊断、治疗及预后。方法回顾性分析2016年9月至2020年9月就诊于中国人民解放军总医院第一医学中心妇产科、因子宫及附件良恶性肿瘤行全子宫切除后宫颈液基细胞学(thinprep cytologic test,TCT)及人乳头瘤病毒(human papillomavirus,HPV)筛查异常、行阴道镜下活检、病理证实为VaIN的80例患者的临床及病例资料。结果①按患者的病变级别分为高级别鳞状上皮内病变(high grade squamous intraepithelial lesion,HSIL)组及低级别鳞状上皮内病变(low grade squamous intraepithelial lesion,LSIL)组,两组患者的发病年龄、全子宫切除至发现病变时间间隔比较,差异均无统计学意义(P>0.05);②80例患者中,77例(96.3%)存在高危型HPV感染,HSIL组HPV16感染率(55.0%,22/40)高于LSIL组(12.5%,5/40)(P<0.05);③71例患者TCT异常,检出HSIL的敏感度52.1%,包括18例无明确诊断意义的非典型鳞状上皮细胞(atypical squamous cells of undetermined signification,ASCUS)、35例LSIL、9例非典型鳞状上皮细胞,不除外高度鳞状上皮内病变(atypical squamous cells-cannot exclude HSIL,ASC-H)和9例HSIL,病变级别与TCT结果有关(P<0.05);④按子宫切除病因分为宫颈因素切除子宫组与非宫颈因素组,两组发病年龄分别为(53.2±9.5)岁和(57.4±6.2)岁,全子宫切除至病变时间间隔分别为(47.4±42.0)个月和(141.7±89.4)个月,HPV 16感染率分别为(40.7%,22/54)和(19.2%,5/26),两组以上指标比较,差异均有统计学意义(P<0.05);但两组的病变级别、TCT筛查结果均无明显差异(P>0.05)。结论全子宫切除后定期对阴道残端进行TCT联合HPV筛查是必要的,宫颈因素切除子宫是VaIN的高危因素,对此类患者更应加强随访。

Objective To explore the clinical features,diagnosis,treatment and prognosis of post-hysterectomy vaginal intraepithelial neoplasia(VaIN).Methods A retrospective analysis was conducted on clinical data of 80 patients from the First Medical Center of The General Hospital of the People's Liberation Army from September 2016 to September 2020 with VaIN,who accepted hysterectomy for benign or malignant diseases and were diagnosed with VaIN pathologically for abnormal TCT or HPV tests.Results①The patients were divided into high grade squamous intraepithelial lesion(HSIL)group and low grade squamous intraepithelial lesion(LSIL)group according to the lesion grade.There was no difference on age and interval between hysterectomy and VaIN between LSIL group and HSIL group(P>0.05).②77 cases(96.3%)had high risk HPV,The infection rate of HPV16 in HSIL group(55.0%,22/40)was higher than that in LSIL group(12.5%,5/40)(P<0.05).③71 cases had abnormal TCT,including 18 ASCUS,35 LSIL,9 ASC-H and 9 HSIL.We found that grades of lesion were connected with TCT results(P<0.05).④According to the causes of hysterectomy,the patients were divided into cervical-caused hysterectomy group and non-cervical factor group.The onset ages of the two groups were(53.2±9.5)years and(57.4±6.2)years,respectively.The difference on age,interval and HPV 16 infection rate between the two groups was statistically significant(P<0.05).However,there were no significant differences in lesion grade and TCT screening results between the two groups(P>0.05).Conclusion Regular TCT combined with HPV screening for patients with hysterectomy is necessary.Hysterectomy for cervical factors is a high risk factor for VaIN,and follow-up should be strengthened for these patients.