阴道内镜诊治子宫切除术后阴道上皮内瘤变效果  

Application value of the vaginal endoscopy in the diagnosis and treatment of the vaginal intraepithelial neoplasia of patients after hysterectomy

作　　者：王丽萍 张月 孙滨洲 王岩岩 WANG Liping;ZHANG Yue;SUN Binzhou;WANG Yanyan(Qinhuangdao Maternal and Child Health Care Hospital,Qinhuangdao,Hebei Province,066000)

机构地区：[1]河北省秦皇岛市妇幼保健院,066000

出　　处：《中国计划生育学杂志》2024年第10期2419-2422,共4页Chinese Journal of Family Planning

基　　金：秦皇岛市重点研发计划科技支撑项目(202301A201)。

摘　　要：目的:探究阴道内镜在诊治子宫切除术后阴道上皮内瘤变(VAIN)中的应用价值。方法:回顾分析本院2020年10月-2022年10月收治的120例子宫切除术后VAIN患者资料,均为术后复查发现薄层液基细胞学结果异常及(或)高危人乳头瘤病毒(HPV)阳性患者,所有患者均接受阴道镜及阴道内镜检查。以最终病理诊断为标准,探究阴道内镜在诊断子宫切除术后VAIN中的诊断价值。结果:120例子宫切除术后VAIN患者,共计167处病变,其中阴道壁125处(74.9%),阴道顶角42处(25.1%);高级别鳞状上皮内病变(HSIL)113处(67.7%),低级别鳞状上皮内病变(LSIL)54处(32.3%);VAINⅠ级54处(32.3%),Ⅱ级74处(44.3%),Ⅲ级39处(23.3%);有宫颈上皮内瘤变(CIN)病史65例(54.2%),合并高危HPV阳性89例(74.2%)。阴道镜联合阴道内镜检查VAIN检出率、不同程度VAIN检出率均高于单纯阴道镜检查,差异有统计学意义(P<0.05);阴道镜联合阴道内镜检查阴道顶角VAIN检出率高于单纯阴道镜检查,差异有统计学意义(P<0.05),而阴道壁VAIN检出率差异无统计学意义(P>0.05);120例VAIN患者随诊观察45例(37.5%),CO_(2)激光汽化治疗39例(32.5%),药物治疗27例(22.5%),阴道局部切除手术治疗9例(7.5%),89例合并高危HPV患者均接受抗HPV治疗。结论:联合阴道镜与阴道内镜检查有助于提高子宫切除术后VAIN检出率,有利于指导疾病管理措施,保证患者生命健康。Objective:To explore the application value of vaginal endoscopy in the diagnosis and treatment of vaginal intraepithelial neoplasia(VAIN)of patients after hysterectomy.Methods:The data of 120 patients with VAIN after hysterectomy in the hospital from October 2020 to October 2022 were retrieved.The samples were collected from the patients with abnormal results of thinprep cytology test(TCT)and/or with positive high-risk human papillomavirus(HPV)after surgery.All these patients had received examination of the colposcopy combined with vaginal endoscopy.The diagnostic value of the vaginal endoscopy for the VAIN of the patients after hysterectomy was explored based on their final pathological diagnosis as the gold standard.Results:167 lesions of these patients were found among 120 patients with VAIN after hysterectomy,including 125(74.9%)lesions in vaginal wall and 42(25.1%)lesions in vaginal apex,113(67.7%)lesions with high-grade squamous intraepithelial lesions(HSIL)and 54(32.3%)lesions with low-grade SIL lesions(LSIL),and 54(32.3%)lesions with VAIN grade I,74(44.3%)lesions with VAIN grade II and 39(23.3%)lesions with VAIN gradeⅢ.There were 65(54.2%)patients with cervical intraepithelial neoplasia(CIN)and 89(74.2%)patients with positive high-risk HPV.The detection rates of the VAIN and the different degrees of VAIN of the patients by colposcopy combined with vaginoscopy were significantly higher than those of the patients by colposcopy alone(P<0.05).The detection rate of the vaginal apex VAIN of the patients by colposcopy combined with vaginoscopy was significantly higher than that of the patients by colposcopy alone(P<0.05),but the detection rate of the vaginal wall VAIN of the patients by colposcopy combined with vaginoscopy had no significantly different from that of the patients by colposcopy alone(P>0.05).In 120 patients with VAIN,there were 45(37.5%)cases given followed up and observation,39(32.5%)cases with treated by CO_(2) laser vaporization,27(22.5%)cases with the treatment of drug and 9(7.5%)cases with

关 键 词：子宫切除术 阴道镜 阴道内镜 阴道上皮内瘤变 

分 类 号：R737.33[医药卫生—肿瘤]