4562例阴道上皮内瘤变和阴道癌的临床特征分析  

Clinical features of vaginal precancer and cancer:a retrospective study of 4562 cases in China

作　　者：张璐 汪清[2] 张宏伟[2] 杜明[2] 高蜀君[2] 谢锋[2] 董晶[2] 丰华[2] 陈敏[2] 陈丽梅[2] 朱彩英[2] 刁雯静[2] 宋昱[2] 郭奇桑[2] 李燕云[2] 曹远奎 周奇[2] 李清[2] 隋龙[2] 丛青[2] Zhang Lu;Wang Qing;Zhang Hongwei(Department of Obstetrics and Gynecology,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011;Medical Center of Diagnosis and Treatment for Cervical Diseases,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011)

机构地区：[1]复旦大学附属妇产科医院妇产科,上海200011 [2]复旦大学附属妇产科医院宫颈与阴道早期疾病诊疗中心,上海200011

出　　处：《现代妇产科进展》2021年第9期646-650,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨阴道上皮内瘤变(VaIN)和阴道癌患者的临床特征。方法:收集2018年1月1日至2019年12月31日在复旦大学附属妇产科医院黄浦院区经阴道镜活检诊断为VaIN或阴道癌的女性4562例。回顾分析患者的细胞学、高危型HPV(hrHPV)和阴道镜诊断等临床特征。结果:VaIN 1、VaIN 2/3和阴道癌分别占85.2%、13.6%和1.2%;细胞学敏感度分别为66.8%、80.3%和76.0%。全子宫切除术后患者较未切除全子宫患者的细胞学敏感度升高(75.3%vs 67.5%,P<0.01)。hrHPV敏感度分别为85.1%、93.5%和83.3%,平均86.2%。VaIN 1患者的hrHPV52感染率最高(24.7%),其次为hrHPV16(23.7%)和hrHPV58(21.2%),VaIN 2/3和阴道癌患者的hrHPV16感染率最高,分别为64.3%和95.5%;阴道镜诊断准确率分别为77.6%、47.7%和89.1%。结论:细胞学和hrHPV检测是阴道病变筛查的重要方法;VaIN2/3相比阴道癌和VaIN1具有更高的细胞学和hrHPV检测敏感性;阴道镜检查对发现阴道病变具有重要的定位作用,阴道镜诊断阴道癌相比VaIN1和VaIN2/3准确性更高。Objective:To investigate the clinical features of vaginal intraepithelial neoplasia(VaIN)and vaginal cancer.Methods:4562 women diagnosed as VaIN or vaginal cancer by colposcopy biopsy in the Obstetrics and Gynecology Hospital of Fudan University in Huangpu District during January 1st,2018 to December 31st,2019 were enrolled.Retrospective analysis was applied in terms of cytology,high-risk HPV(hrHPV)and colposcopy diagnosis and other clinical features.Result:From the data collected,the percentages of VaIN 1,VaIN2/3 and vaginal cancer were 85.2%,13.6%and 1.2%,along with respective sensitivity ratio of cytology 66.8%、80.3%、76.0%.The overall sensitivity of cytology was significantly higher in patients underwent hysterectomy than that of patients without hysterectomy(75.3%vs 67.5%;P<0.01).The sensitivity value of hrHPV were 85.1%,93.5%and 83.3%for VaIN 1,VaIN 2/3 and vaginal cancer,respectively,with average rate of 86.2%.For patient group diagnosed with VaIN 1,hrHPV52(24.7%)was the most prevalent HPV type,followed by hrHPV16(23.7%)and hrHPV58(21.2%).In addition,for patient group diagnosed with VaIN 2/3 and vaginal cancer,hrHPV16 was the most prevailing HPV type with infection rate to be 64.3%and 95.5%respectively.The accuracy rates of colposcopic impression were 77.6%,47.7%,and 89.1%for VaIN 1,VaIN 2/3 and vaginal cancer,respectively.Conclusion:Cytology and hrHPV detection are important methods for vaginal lesion screening in women after hysterectomy and with an intact uterus.VaIN2/3 has higher sensitivity for cytology and hrHPV detection than vaginal cancer and VaIN1.Colposcopy-directed biopsy is pivotal in detecting VaIN and vaginal cancer.

关 键 词：阴道镜 人乳头瘤病毒 阴道上皮内瘤变 阴道癌 

分 类 号：R737.33[医药卫生—肿瘤]