摘要
目的探讨宫颈癌及宫颈上皮内瘤变术后阴道上皮内瘤变(VaIN)患者的临床特征、诊断、治疗及预后。方法回顾性分析首都医科大学附属北京妇产医院2011年1月至2013年1月诊治的宫颈癌及宫颈上皮内瘤变术后48例VaIN患者的临床资料。结果 48例患者均无明显临床症状,均以阴道残端细胞学异常就诊。既往病史中,宫颈癌病史26例(54.17%),宫颈上皮内瘤变病史22例(45.83%)。共发现VaINⅠ17例(35.42%),VaINⅡ18例(37.50%),VaINⅢ13例(27.08%)。VaIN患者高危型人乳头瘤病毒阳性者45例(93.75%),阴性者3例(6.25%)。VaIN发生于阴道上1/3的患者41例(85.42%),其他部位者7例(14.58%)。43例(89.58%)患者病变呈多灶性分布,5例(10.42%)呈局灶性分布。VaIN的治疗方法有CO2激光汽化治疗31例、局部药物治疗13例、局部切除3例和腔内放疗1例。治疗后病变近期局部控制率为100%,4例(8.33%)VaINⅢ患者复发,再次激光治疗后病变得到有效控制。结论阴道上皮内瘤变诊断困难,最常发生于宫颈癌及宫颈上皮内瘤变术后,常合并高危型人乳头瘤病毒感染,病变多位于阴道上1/3,呈多灶性分布。激光治疗及局部用药均可有效控制VaIN,且具有良好的耐受性。但由于VaIN的易复发性,需进行长期严密的随访。
Objective To Explore the clinical characteristics,diagnosis,therapeutic modalities and prognosis of patients with vaginal intraepithelial neoplasia（VaIN）after operation of cervical cancer and cervical intraepithelial neoplasia.Methods The clinical data of 48 cases with VaIN after operation of cervical cancer and cervical intraepithelial neoplasia in Capital University of Medical Science Affiliated Beijing Obstetrics and Gynecologic Hospital from Jan.2011 to Jan.2013 were reviewed and analyzed retrospectively.Results Among the 48 cases with VaIN,there were no obvious symptoms in all patients,who visited doctor for VaIN treatment due to abnormal pap smears of vagina residue.As for the past medical history,26 cases （54.17%） had cervical cancer history,22 cases（45.83%） had cervical intraepithelial neoplasia history.Histological analysis revealed 17 cases of VaINI（35.42%）,18 cases of VaIN Ⅱ （37.50%）,13 cases of VaIN Ⅲ（27.08%）.There were 45 cases（93.75%） of high-risk HPV positive,3 cases（6.25%） of negative.41 cased 85.42%） of VaIN were located in the upper one third of the vagina,7 cases （14.58%） were located in other part of vaginal wall.43 cases（89.58%）presented muhifocal lesions,5 cases（10.42%） presented focal lesion.The therapeutic modalities of VaIN included CO2 laser vaporization（31 cases）,focal medicine application（13 cases）,local excision（3 cases）and intracavitary radiotherapy （1 case）.The local control rate was 100% in the near future,4 cases（8.33%） VaIN Ⅲ recurred and was effectively controlled after a repeated CO2 laser vaporization.Conclusion VaIN is difficult to be diagnosed,which frequently occurrs after operation of cervical cancer and cervical intraepithelial neoplasia,and commonly associated with high-risk human papillomavirus infection.VaIN is mostly located in the upper one third of the vagina and may involve muhiple lesions.Both CO2 laser vaporization and focal medicine application can effectively control the disease with good tolerance performance,However,a long-term follow-up is required due to the easy recurrence of VaIN.
出处
《医学综述》
2014年第14期2622-2625,共4页
Medical Recapitulate
基金
首都医科大学附属北京妇产医院院级课题(200913)
关键词
阴道上皮内瘤变
宫颈癌
宫颈上皮内瘤变
Vaginal intraepithelial neoplasia
Cervical cancer
Cervical intraepithelial neoplasia
