阴道高级别鳞状上皮内病变手术治疗28例临床分析

Surgery of high-grade vaginal squamous intraepithelial lesions:an analysis of 28 clinical cases

目的探讨因阴道高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)手术治疗患者的临床病理特征及疗效。方法回顾性分析2012年1月至2023年3月本院因阴道HSIL行手术切除治疗28例患者的临床资料。结果28例患者年龄(51.71±11.19)岁,合并宫颈HSIL或宫颈癌患者24例(85.7%);术前宫颈液基细胞学未明确诊断意义的不典型鳞状细胞(ASC-US)及以上者19例,高危型人乳头瘤病毒(HPV)阳性者27例;28例患者中,阴道镜下病灶数量≥2个部位者18例,位于阴道上1/3者20例。阴道镜活检病理<阴道上皮内瘤变(VaIN)3者15例,VaIN3者13例,手术前后病理诊断不一致者14例,其中13例术后病理诊断降级,VaIN3患者的术后病理相符率显著高于<VaIN3患者(P<0.05);行病灶局部切除术者14例,阴道上段切除术者10例,全阴道切除术者4例。中位随访时间32个月(6~78个月),复发3例,进展2例,复发及进展率17.9%,术前均为VaIN3级患者,术后高危HPV均持续阳性。结论阴道HSIL常与宫颈HSIL共存,病灶常位于阴道上1/3,且呈多灶性,手术治疗有效率高,既往因宫颈癌或CIN切除子宫、VaIN 3及术后高危HPV持续阳性患者易出现复发或进展,建议首选手术治疗,术后密切随访。

Objective To analyze the clinicopathological features and effect of patients who underwent surgery for high-grade squamous intraepithelial lesion(HSIL)of vagina.Methods The clinical records and follow-up data of patients with vaginal HSIL from January 2012 to March 2023 in Peking University People's Hospital were analyzed.Results Total of 28 patients were included in the study,with an age of(51.71±11.19)years old.There were 24 patients(85.7%)with cervical HSIL or cervical cancer.27 cases with high-risk human papilloma virus(HPV)positive.Among the 28 patients,the number of lesions in colposcopy was≥2 sites in 18 cases,located in the upper third of the vagina in 20 cases.The pathological findings of colposcopy biopsy were<VaIN3 in 15 cases,VaIN3 in 13 cases,the pathological diagnosis was inconsistent in 14 cases,among which 13 cases were downgraded.The postoperative pathological coincidence rate of patients with VaIN3 was significantly higher than that of<VaIN3(P<0.05).14 cases underwent local excision,10 cases underwent upper vaginal resection,and 4 cases underwent total vagotomy and vaginoplasty.The median follow-up time was 32 months(6~78 months).There were 3 cases of recurrence and 2 cases of progression,and the recurrence and progression rate was 17.9%.All patients were VaIN3 patients before the operation,and all of them were positive for high-risk HPV after the operation.Conclusions Vaginal HSIL often coexists with cervical lesions,and is closely related to high-risk HPV infection.The lesions are often located in the upper third of the vagina and are multifocal.The effective rate of surgical treatment is high,and previous hysterectomy due to cervical cancer or CIN,patients with VaIN3 and high-risk HPV after operation are prone to relapse or progress.It is suggested that surgical treatment should be the first choice,and close follow-up should be conducted after operation.