阴道上皮内瘤变13例临床分析  

Clinical analysis of 13 cases with vaginal intraepithelial neoplasia

作　　者：杨悦[1] 高永良[1] 于爱军[1] 章杰捷[1] 

机构地区：[1]浙江省肿瘤医院妇瘤科,杭州310022

出　　处：《中华妇产科杂志》2010年第3期197-200,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 探讨阴道上皮内瘤变（VAIN）的病因、临床特点、诊断、治疗及预后.方法 回刎顾性分析浙江省肿瘤医院2002年3月至2008年12月收治的13例VAIN患者的临床资料,其中2例为VAINⅡ、11例为VAINⅡ～Ⅲ或VAINⅢ.结果 13例VAIN患者中,行人乳头状瘤病毒（HPV）检测12例,其阳性率为92%（11/12）.VAIN临床表现无特异性,1例阴道分泌物增多;4例阴道局部糜烂充血或呈乳头状增生,2例小结节状改变.13例VAIN患者中,合并宫颈癌6例、宫颈上皮内瘤变（CIN）4例外阴上皮内瘤变（VIN）3例;与宫颈病变（包括宫颈癌和CIN）同时确诊5例、与外阴病变（即VIN）同时确诊3例,其余5例均在复查这些疾病时确诊.与宫颈病变或外阴病变同时确诊的8例VAIN患者采用手术治疗,其中l例VAIN合并CIN因病变广泛术后补充氩气刀治疗,1例VAIN合并VIN因术后切缘阳性补充氩气刀治疗;1例中晚期宫颈癌行同步放化疗后随访时发现的VAIN患者行根治性放疗;3例术后随访时发现的VAIN（VAINⅡ、VAINⅡ～Ⅲ、VAINⅢ各1例）行氩气刀治疗;1例宫颈癌Ⅲb期合并VAINⅢ患者治疗.本组患者的平均随访时间为25.6个月（6～87个月）,2例患者因宫颈癌发生远处转移而死亡,11例活检或阴道液基薄层细胞学检查（TCT）无异常,随访期内无一例进展为浸润癌.结论 HPV感染是VAIN发病的主要原因;VAIN的临床表现隐匿,多在治疗或复查宫颈病变、外阴病变时确诊;治疗以手术为主;VAIN很少进展为浸润癌,预后较好.Objective To investigate the pathogenesis,high risk factors,clinical characteristics,methods of diagnosis and treatment,and prognosis of vaginal intraepithelial neoplasia （VAIN）.Methods The clinical data of thirteen cases of VAIN treated in Zhejiang Provincial Cancer Hospital dated Mar.2002 through Dec.2008 were reviewed and analyzed retrospectively.Results Twelve of 13 VAIN cases were performed the human papillomavirus（HPV） detection with 92% （11/12） HPV positive rate.None of the cases shown specific clinical manifestation.Among the 13 cases,6 of them accompanied with cervical cancer,4 cases with cervical intraepithelial neoplasia （CIN ）,and 3 cases with vulvar intraepithelial neoplasma （VIN）.Five cases synchronously diagnosed with cervical lesion and 3 with vulva lesion were underwent surgery,while the other 5 cases were diagnosed metachronously.Among 8 cases underwent surgery,1 case with CIN underwent argon plasma coagulation （APC） after surgery,1 case with the positive edge of VIN underwent APC.During follow up,1 case with locally advanced cervical cancer underwent radiotherapy again,3 cases with VAIN received APC,while 1 cervical cancer cases with VAIN received no treatment.The average follow-up time was 25.6 months （range 6-87 months）.Two cases died of cervical cancer metastasis.The other 11 cases were normal and still alive.None of them progressed to invasive carcinoma.Conclusions The main reason of VAIN is HPV infection.There are not specific clinical manifestations,usually diagnosed when reviewing cervical or vulva lesions and rarely progressed to invasive carcinoma.The main treatment of VAIN is surgery with the adjuvant treatment of APC.

关 键 词：阴道肿瘤 癌前状态 乳头状瘤病毒感染 

分 类 号：R737.33[医药卫生—肿瘤]