宫颈癌及高级别宫颈上皮内瘤变子宫切除术后阴道上皮内瘤变88例临床分析  

88 Cases of Clinical Analysis of Vaginal Intraepithelial Neoplasia after Hysterectomy of Cervical Cancer and High-Grade Cervical Intraepithelial Neoplasia

作　　者：刘巧[1] 丁晖[1] 吴宜林[1] 陈蒲香[1] 

机构地区：[1]中南大学湘雅二医院,湖南长沙410011

出　　处：《实用妇产科杂志》2017年第6期438-442,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨宫颈癌及高级别宫颈上皮内瘤变(CINⅡ及以上,简称CINⅡ+)子宫切除术后阴道上皮内瘤变(VaIN)的临床特点、诊断及治疗。方法:回顾性分析收治的宫颈癌及CINⅡ+术后门诊规律随访时经阴道镜下活检发现的88例VaIN患者(VaINⅠ55例,VaINⅡ23例,VaINⅢ10例)的临床病理资料。结果:(1)88例患者中82例(93.18%)无明显临床症状。发生VaINⅠ的中位年龄(47.23岁)低于VaINⅡ+(50.75岁),差异有统计学意义(P<0.05)。(2)CINⅡ+和宫颈癌术后发生VaIN的平均时间为22.01±4.13月,CINⅡ+及宫颈癌术后2年内发现VaIN的比率(65.90%)高于2年及以上(34.10%),差异有统计学意义(P<0.05)。(3)TCT、HPV及两者联合筛查VaIN的敏感性分别为44.57%、69.31%、87.50%,差异有统计学意义(P<0.05)。(4)HPV感染:61例HPV感染的VaIN患者中,高危型HPV感染58例(95.08%)。发生VaIN时HPV感染亚型与既往CINⅡ+或宫颈癌时HPV感染亚型相同的VaINⅡ+所占比例(56.00%)多于VaINⅠ(17.78%),差异有统计学意义(P<0.05)。(5)共失访8例(9.09%)。50例VaINⅠ患者均未治疗,随访24例(48.00%)患者转为正常,23例(46.00%)患者为持续VaINⅠ状态,3例(6.00%)进展为VaINⅡ。未行治疗的VaINⅡ患者7例,规律随访6例,无一例进展;经手术治疗的VaINⅡ+患者24例,无一例进展为阴道癌。1例持续的阴道或外阴上皮的中重度不典型增生,共行4次手术治疗。结论:VaIN多无临床症状,易漏诊;随年龄的增加,VaIN的级别较高。CINⅡ+及宫颈癌术后2年内应密切监控VaIN的发生。HPV和TCT联合筛查能提高对VaIN的诊断。检测特定类型的HPV感染对于识别VaIN风险有一定重要性。VaINⅠ采用观察治疗可行,VaIN病变均应严密随访。Objective：To investigate the clinical characteristics,diagnosis and treatment, prognosis of vaginal intraepithelial neoplasia（VaIN） after hysterectomy of Cervical cancer and high-grade cervical intraepithelial neo- plasia（ CIN II＋ ）. Methods：A retrospective study was made of 88 patients with VaiN,who were diagnosed by Pa- thology when regular follow-up after operation of cervical cancer and CIN II＋（55 cases of VaIN I ,23 cases of VaIN II and 10 cases of ValNIII ）. Results：①Among the 88 cases with VAIN,82 cases had no obvious clinical symptoms. The median age of VaIN I （47.23 years old） was lower than VaIN II （50.75 years old） ,which had statistically significant differences（ P 〈0.05）. ②VaIN that occurred after CIN II ＋ and cervical cancer＇s operation were on an average time of 22.01 ±4. 13 months,and the onset ratio within 2 years（65.90% ） was higher than above 2 years （34. 10% ）, differences on the ratio was statistically significant（ P 〈 0.05）. ③There was statistically significant differences on the sensitivity of the detection of VaIN among with TCT,with HPV and with combining both（44.57% ,69.31% and 87.50% respectively, P 〈 0.05）. ④HPV infection.61 patients had positive HPV in- fection,including 58 patients with high-risk type HPV infection（95.08% ）. The proportion that the same subtype ofHPV on CIN II＋ or cervical cancer,of VAIN II/III （56.00%） was more than VaIN I（ 17.78% ） ,the difference was statistically significant（ P 〈 0. 05）. ⑤80 patients had regular foltow-up, and the lost to follow-up rate was 9. 09% （8 cases）. 50 patients with VAIN I were no treated. 24 patients（48.00% ） turned into normal,23 patients（46.00% ） had no change,and 3 cases（6.00% ） worsen to VaIN II. 7 patients with VaIN 11 were not treated. 6 patients had regular follow-up of and no one worsen. 24 patients with VaINII＋ were treated by surgery,and on one worsen to a vaginal carcinoma. 1 case continued in VaIN or V/N,and received

关 键 词：阴道上皮内瘤变 人乳头瘤病毒 宫颈癌 宫颈上皮内瘤变 

分 类 号：R711.74[医药卫生—妇产科学]