Ⅰ期子宫颈癌和子宫颈上皮内瘤变Ⅲ患者合并阴道上皮内瘤变的临床分析  

Clinical analysis of patients underwent hysterectomy for stage Ⅰ cervical cancer or high grade cervical intraepithelial neoplasia with vaginal intraepithelial neoplasia

作　　者：何玥[1] 吴玉梅[1] 赵群[1] 樊蓓[1] 徐小红[1] 朱力[2] 张为远[3] 

机构地区：[1]首都医科大学附属北京妇产医院妇瘤科,100006 [2]首都医科大学附属北京妇产医院病理科,100006 [3]首都医科大学附属北京妇产医院产科,100006

出　　处：《中华妇产科杂志》2015年第7期516-521,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：北京市科技计划（D131100005313009）;首都医科大学附属北京妇产医院科学研究基金（2013-11）

摘　　要：目的探讨Ⅰ期子宫颈癌和子宫颈上皮内瘤变（CIN）Ⅲ合并阴道上皮内瘤变（VAIN）患者在行子宫切除术前先行阴道镜下阴道壁活检病理检查的必要性。方法2009年1月1日至2013年12月31日5年问首都医科大学附属北京妇产医院收治的Ⅰ期子宫颈癌或CINⅢ行子宫切除术的患者共669例，其中合并VAIN者99例，收集这99例患者的临床病理和随访资料进行回顾性分析。结果（1）669例Ⅰ期子宫颈癌或CINⅢ行子宫切除术的患者中，合并VAIN者99例（14．8％，99／669），其中15例患者于子宫切除术前行阴道镜下阴道壁活检病理检查诊断为VAIN，84例患者于子宫切除术后阴道组织病理检查诊断为VAIN。随着子宫颈病变程度的增高，CINⅢ及Ⅰa期、Ⅰb期子宫颈癌患者合并VAIN的比例（F=17．627，P=0．000）及级别明显增高（F=19．941，P=0．001），其合并VAIN的比例分别为10． ％（35／349）、14．3％（16／112）、23．1％（48／208）。（2）I期子宫颈癌或CINⅢ患者合并VAIN的级别，与子宫颈病变患者的年龄、绝经状态、HPV感染状态、腹腔镜手术情况、手术范围、子宫颈病变程度以及子宫颈癌的病理分化程度、病理类型、脉管癌栓状态、淋巴结转移状态均无明显关系（P〉0．05）。（3）99例Ⅰ期子宫颈癌或CINⅢ合并VAIN行子宫切除术的患者中，术后随访1～5年发现残端VAIN12例（其中术后3年内发现11例）；这12例残端VAIN患者中11例术前未行阴道镜下阴道壁活检，其中4例残端VAIN病变进展（指病变级别升高），总进展率为4．0％（4／99），这4例病变进展患者中2例为残端阴道癌，残端复发率为2．0％（2／99）。结论对于因Ⅰ期子宫颈癌或CINⅢ行子宫切除术的患者，建议术前常规行阴道镜下阴道壁活检病理检查，以决定手术中阴道切除的范围；且术后应对阴道残端定期随诊，尤其术后3年内，以�Objective To analyse the necessity of colposcopie directed biopsy to vaginal intracpithclial ncoplasia （VAIN） before hysterectomy due to early stage cervical cancer （stage Ⅰ ） or high grade cervical intraepithelial neoplasia （CIN）. Methods A total of 669 patients who underwent a hysterectomy due to early stage cervical cancer （stage Ⅰ ） and CIN Ⅲ in Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from January 1, 2009 to December 31, 2013 and followed up, 99 patients with VAIN were enrolled. The clinical data and following up the prognosis were prospectively analyzed retrospectively. Results The occurrence rate of VAIN before and after hysterectomy due to cervical dysplasia was 14.8% （99/669）, the occurrence rate and the grade of VAIN showed that significantly increased from CIN Ⅲ to cervical cancer stage Ⅰ （P〈0.05）; Only 15 patients enrolled had undergone vaginal wall biopsy by colposcopy pre-hysterectomy, including 11 patients who were diagnosed with VAIN Ⅱ- Ⅲ and underwent vagina extended resection during the hysterectomy. The 5 year recurrence rate of vaginal stump VAIN after hysterectomy was 12.1% （12/99） and the progression rate was 4.0% （4/99）, the recurrent rate was 2.0% （2/99）. Conclusions For all the patients who are planning to undergo hysterectomy due to stage Ⅰ cervical cancer and CIN Ⅲ, routine upper side of the vagina wall colposcopic-directed biopsy prehysterectomy is strongly recommended. All the patients after hysterectomy due to cervical dysplasia should be followed up regularly within 3 years after hysterectomy.

关 键 词：宫颈肿瘤 宫颈上皮内瘤样病变 阴道肿瘤 原位癌 

分 类 号：R737.33[医药卫生—肿瘤]