阴道上皮内瘤变六例临床分析  

Clinical analysis of six eases of vaginal intraepithelial neoplasia

作　　者：张庆霞[1] 朱兰[1] 郎景和[1] 沈铿[1] 黄惠芳[1] 潘凌亚[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院妇产科,100730

出　　处：《中华妇产科杂志》2008年第3期193-196,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨阴道上皮内瘤变（VAIN）的临床特点、诊断和治疗方法。方法回顾性分析1980-2006年间北京协和医院收治的6例VAIN患者的临床资料。结果5例VAIN患者（5／6）发生于子宫全切除术后，其中2例因宫颈癌和（或）宫颈上皮内瘤变（CIN）切除子宫。4例患者检测过人乳头状瘤病毒，结果均为阳性。6例患者均无特异的临床症状，均是在细胞学涂片检查发现异常后经阴道镜活检确诊为VAIN，其病变部位均位于阴道上1／3。6例VAIN患者均行阴道病灶切除术治疗，1例因切缘有病变累及行二次手术。2例患者术后随诊1年液基薄层细胞学检查（TCT）结果无异常；3例术后随诊6个月时TCT结果有异常；1例术后6个月时TCT结果异常而1年时TCT结果正常。结论CIN病史是VAIN发病的主要危险因素，因CIN而切除子宫的患者需定期进行阴道细胞学检查；发现阴道细胞学异常后行阴道镜活检是诊断VAIN的主要方法；对于VAINⅡ-Ⅲ患者常首选手术治疗；VAIN治疗后易复发。Objective To investigate the clinical characteristics, diagnosis and treatment of vaginal intraepithelial neoplasia （VAIN）. Methods A retrospective study was made of 6 patients with VAIN, who were hospitalized at Peking Union Medical College Hospital from 1980 to 2006. Results Five cases had a history of hysterectomy, two of whom were because of cervical intraepithelial neoplasia （CIN） or invasive cervical cancer. Four cases had the infection of high-risk oncogenic human papillomaviruses detected with hybrid capture Ⅱ （HC-Ⅱ）, the other two had no record. In all patients the VAIN lesions were within the upper one third of the vagina. They were all diagnosed by colposcopic examination and directed biopsy after the abnormal cytology by thinprep cytology test （TCT）. Six cases of VAIN Ⅱ- Ⅲ were treated by excisional surgery. One case had residual lesion and had another surgery 3 months after the first one. Two patients obtained remission at one-year follow-up, three had abnormal cytology by TCT 6 months after surgery, and one had abnormal cytology by TCT at six-month follow-up but normal at one-year follow-up. Conclusions A history of CIN is the main risk factor for VAIN, so routine vaginal cytology is needed for the patients after hysterectomy due to CIN. Cytology, colposcopic examination and directed biopsy are the mainstays of VAIN diagnosis. Excisional surgery is recommended for the patients with VAIN Ⅱ - Ⅲ. Long term follow-up is necessary after treatment.

关 键 词：阴道肿瘤 癌前状态 乳头状瘤病毒 人 

分 类 号：R686[医药卫生—骨科学]