外阴上皮内瘤变Ⅲ级35例临床分析  

Clinical analysis of 35 cases of vulvar intraepithelial neoplasia grade Ⅲ

作　　者：张功逸[1] 吴令英[1] 李斌[1] 杨琳[2] 赵丹[1] 俞高志[1] 

机构地区：[1]中国医学科学院肿瘤医院妇瘤科,北京100021 [2]中国医学科学院肿瘤医院病理科,北京100021

出　　处：《中华妇产科杂志》2009年第3期163-166,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨外阴上皮内瘤变Ⅲ级（VINⅢ）的病因、临床病理特点、治疗方式以及预后。方法对中国医学科学院肿瘤医院1993年1月至2008年4月收治的35例VINⅢ患者的临床及病理资料进行回顾性分析。结果35例患者均因出现临床症状而就诊，表现为外阴瘙痒及肿物；其中28例（80％）病灶呈多发性斑块，7例（20％）病灶为单发性。15例（43％）合并人乳头状瘤病毒（HPV）相关疾病。22例（63％）病理检查发现有HPV感染证据（镜检时在病变范围内发现挖空细胞）。35例患者中，1例未治疗，其余34例（97％）患者接受了手术治疗，其中14例患者行肿物局部扩大切除术；另20例行单纯外阴切除术，其中4例同时行肛门周围皮肤切除术。2例切缘阳性，其中1例术后补充局部放疗。4例患者分别于术后2、4、6及22个月局部复发，分别接受了激光及手术治疗。对本组病例随访1-166个月（中位随访时间为66个月），除1例死于宫颈癌外，无一例死于本病。接受生活质量调查的26例患者中有9例（35％）术后性生活质量受到不同程度的影响，其中1例接受了外阴整形术。结论VINⅢ的发生可能与HPV感染有关，部分患者可同时合并HPV相关疾病。本病预后良好，手术为主要治疗手段，但可能影响性生活质量。Objective To evaluate the etiology, clinicopathological characteristics, treatment and prognosis of VIN Ⅲ. Methods Thirty-five patients with VIN Ⅲ admitted in Cancer Hospital of Chinese Academy of Medical Sciences between 1993 and 2008 were analyzed retrospectively. Results All 35 patients attended to hospital with the symptoms of pruritus vulvae and lumps. Among of them, there were 28 （80%） cases whose lesions presented as multiple plaques, while 7 （20%） cases lesion were monofocal. Fifteen out of 35 cases had coexistent with human papillomavirus （HPV） related lesions, and there were the evidence of HPV in 22 patients whose pathologic sections revealed koilocytes. 34 cases （97%） except one received different types of surgical resections, including wide local resection （ 14/34 ） , simple vulvectomy （16/34） and simple vulvectomy plus perianal skin resection （4/34）, while there two cases shown positive cut-edges and one of them received radiotherapy postoperatively. Four out of the 34 cases recurred locally in 2, 4, 6 and 22 months and received surgical treatment again or laser therapy, respectively. The median follow-up period was 66 months （ range 1 - 166） , and none of them were died of the disease itself except one case died of the concurrent cervical cancer. Among 26 cases received the investigation of the quality of life, there were nine cases （35%） suffered from sexual dysfunction after the operation, and one of them received vulvoplasty. Conclusions VIN Ⅲ has good prognosis. The development of VIN Ⅲ may be related to the infection of HPV, because most of them concurrent with HPV diseases. Its primary treatment is surgical resection, while affecting on the quality of life.

关 键 词：外阴肿瘤 癌前状态 癌 原位 乳头状瘤病毒感染 预后 

分 类 号：R686[医药卫生—骨科学]