子宫颈癌或癌前病变术后再发阴道癌或癌前病变的临床分析  

Clinical analysis of 15 cases with vaginal intraepithelial neoplasia and vaginal cancer after operations of cervical cancer or cervical intraepithelial neoplasia

作　　者：刘琦[1] 施雅[1] 张秦[1] 税迎春 管群[1] 石群立[2] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)妇产科,南京医学博士210002 [2]南京大学医学院临床学院(南京军区南京总医院)病理科,南京210002

出　　处：《医学研究生学报》2014年第6期623-626,共4页Journal of Medical Postgraduates

摘　　要：目的高危型人乳头瘤病毒（high risk human papilloma virus,hrHPV）与子宫颈癌及宫颈上皮内瘤样病变（cervical intraepithelial neoplasia,CIN）的相关性已众所周知,但对于与子宫颈癌及CIN有相同发病原因的阴道癌及其阴道上皮内瘤样病变（vaginal intraepithelial neoplasia,VAIN）尚未引起足够重视。文中通过对子宫颈癌或CIN手术后出现阴道癌或VAIN的患者进行临床分析,以期为临床医师针对该病的诊治提供依据。方法回顾性分析2010年1月至2013年5月入住南京军区南京总医院妇产科的15例子宫颈癌或CIN术后出现阴道癌或VAIN患者的临床资料及治疗方法。8例患者（阴道癌3例、VAINⅢ4例、VAINⅡ1例）行全阴道切除（total vaginectomy,TV）,其中1例加行盆腔淋巴结切除;2例（阴道癌1例、VAINⅢ1例）行阴道上段部分切除（upper vaginectomy,UV）;3例阴道癌行放疗或放化疗;2例（VAINⅢ1例、VAINⅡ1例）给与干扰素-α肌内注射及局部雌激素、阿昔洛韦治疗。结果患者平均年龄为（53.60±10.82）岁（39~73岁）,平均发生阴道癌或VAIN的间隔为（25.07±18.31）个月（1~60个月）。原疾病为子宫颈癌者10例,CINⅢ者5例;10例子宫颈癌患者中再发为阴道癌者4例、VAINⅢ者4例、VAINⅡ者2例;5例CINⅢ患者中再发为阴道癌者3例、VAINⅢ者2例。15例患者初发及再发时高危HPV均阳性。在进行12~52个月随访后发现10例手术患者仅1例复发,3例放疗患者病情控制欠理想。结论持续hrHPV感染的子宫颈癌或CIN患者手术后仍有发生阴道癌或VAIN的风险,应严密随访。一旦发生,手术切除阴道效果较好。对手术困难的VAIN者,给与干扰素-α肌内注射及局部雌激素、阿昔洛韦治疗有一定作用,放疗效果欠佳。Objective Although the correlation between high risk human papilloma virus（ hrHPV） infection and cervical cancer（ CC） or cervical intraepithelial neoplasia（ CIN） is well known,vaginal cancer（ VC） or vaginal intraepithelial neoplasia（ VAIN） also caused by hrHPV has not received enough attention.This article aims to explore the clinical characteristics of VC or VAIN after operations of CC or CIN in order to provide evidence for the treatment of these diseases.Methods The clinical characteristics and treatment of 15 cases with VC or VAIN after operations of CC or CIN were reviewed from Jan 2010 to May 2013 in our hospital.Results The mean age was（ 53.6 ± 10.82） years,ranged from 39 to 73 years.The duration from the first operation to developed VAIN or VC was（ 25.07 ± 18.31） months,ranged from 1 to 60 months.There are 4 cases developed VC,4 cases VAINⅢ and2 cases VINⅡ from 10 CC patients; and 3 cases developed VC,2 cases VAINⅢ from 5 CINⅢ patients.hrHPV test were positive in all 15 patients.Treatment in these series were performed including total vaginectomy in 8 patients（ 3 VC,4 VAINⅢ and 1 VAINⅡpatients）,pelvic lymphonectomy in 1; upper vaginectomy in 2 patients（ 1 VC,1 VAINⅢ）,radiation or chemo-radiation therapy in 3（ 3 VC）,interferon muscle injection combined with topical application of estrogen and acyclovir gel in 2（ 1 VC,1 VAINⅡ）.Conclusion Careful follow-up after CC or CIN operations are very important because continued hrHPV infection may result VC and VAIN lesions.Vaginectomy may be the best therapy.Interferon muscle injection combined with topical application of estrogen and acyclovir gel are also alternatively therapy,especially for hard to operate patients.Radiation therapy seems to be not very adaptable for VAIN patients.

关 键 词：宫颈癌术后 CIN术后 阴道上皮内瘤变 阴道癌 HPV感染 

分 类 号：R737.33[医药卫生—肿瘤]