阴道上皮内瘤变20例临床分析  

Clinical analysis of 20 patients with vaginal intraepithelial neoplasia

作　　者：李淑敏[1] 章文华[1] 白萍[1] 李洪君[1] 张蓉[1] 吴令英[1] 

机构地区：[1]中国医学科学院肿瘤医院妇瘤科,北京100021

出　　处：《中华妇产科杂志》2009年第4期277-280,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨阴道上皮内瘤变（VAIN）的临床特征、治疗方法及预后。方法收集中国医学科学院肿瘤医院1999年1月-2007年12月收治的20例VAIN患者的临床资料，对其进行回顾性分析。结果20例患者均无明显临床症状和体征，多数患者（17例，85％）因阴道液基细胞学检查异常或诊断为宫颈癌后而行进一步检查（妇科检查、阴道镜检查及阴道镜下活检组织病理检查）时发现，少数患者（3例，15％）为宫颈癌术后随访时发现。85％（17例）的患者合并宫颈癌（12例）或宫颈上皮内瘤变（CIN，5例）。90％的患者为VAINⅢ，主要发生于阴道上段（17例，85％），且多呈多灶性分布（13例，65％）。VAIN的治疗主要采用手术治疗（13例）和放疗（7例），治疗后的局部控制率达100％。3例（15％）复发患者均为VAINⅢ，其中1例为放疗后复发，2例为手术后复发，分别经手术或放疗后病变仍可得到有效控制。结论单纯性VAIN诊断困难，常合并宫颈癌或CIN，病变多位于阴道上段且呈多灶性分布，手术和放疗均可有效控制VAIN，但治疗后应密切随访，以及早发现、诊断和治疗复发病变。Objective To explore the clinical-pathologic characteristics, treatment modalities and prognosis of patients with vaginal intraepithelial neoplasia （VAIN）. Methods The clinical, pathologic and follow-up data of 20 cases with vaginal intraepithelial neoplasia treated primarily in Cancer Hospital of Chinese Academy of Medical Sciences from Jan. 1999 to Dec. 2007, were reviewed and analyzed retrospectively. Results There were not any of symptoms on diagnosis in all patients, and most of them （17 cases, 85% ） were frequently detected VAIN for the abnormal pap smears or pelvic examination from cervical carcinoma patients and under the colposcopy as well as colposcopic biopsies. There were 3 eases （15%） with cervical cancer were diagnosed as VAIN during the postoperative follow up, while 17 eases （85%） of patients were accompanied with cervical cancer（ 12 cases） or cervical intraepithelial neoplasia （ CIN, 5 cases ） concomitantly or antecedently. Ninety percent of patients were diagnosed as VAIN Ⅲ, 17 eases （85%） were mainly localized in the upper third of vagina, and 13 cases （65%） affected to the multiple vaginal walls. Thirteen cases were performed surgery, and 7 cases were treated by irradiation. The local control rate was achieved to 100% in all of patients. Three cases （ included 1 post-irradiated and 2 postoperative） were relapsed after treatment, but still be controlled completely by radiotherapy or surgery. Conclusions VAIN was difficult to be diagnosed independently, which was frequently accompanied by cervical cancer or CIN, significantly localized in the upper third of vagina involving the multiple walls of vagina, and treated synchronously with cervical carcinoma and CIN accompanying. Surgery and radiotherapy was equally effective to control VAIN, and then follow-up post-treatment should be closely to detect, diagnose and treat recurrent VAIN as soon as possible after treatment.

关 键 词：阴道肿瘤 癌前状态 活组织检查 

分 类 号：R686[医药卫生—骨科学]