重度外阴鳞状上皮内瘤变12例临床分析

目的探讨重度外阴上皮内瘤变（VINⅢ）的诊断、治疗方法及疗效。方法采用回顾性分析的方法收集1984年至2006年我院妇产科收治的VINⅢ患者共12例，记录患者年龄、手术方式、病理特点、手术后随诊情况等等。结果12例患者平均年龄40．3岁（23-56岁），所有患者均出现外阴瘙痒、3例外阴破溃、1例外阴疼痛。病灶单发者2例，多发者10例。合并其他部位瘤变者5例。合并人乳头瘤病毒（HPV）感染者5例。12例患者均行手术治疗：3例单纯外阴切除术者中1例肛周病变切缘未净，9例局部病灶切除术者中4例切缘未净。术后8例患者随诊，其中有3例切缘未净者。平均随诊时间为9．0个月（1-22个月），2例患者分别于术后3、11个月发现新部位病灶需再次治疗，其中1例切缘未净、1例切缘干净。结论对于可疑VINⅢ患者应高度重视，行活组织检查病理学诊断，诊断中可使用阴道镜对宫颈、阴道瘤变进行检查，加强对HPV感染的检测。对于诊断VINⅢ的患者，以局部病灶切除手术后长期随诊为主要的治疗手段。切缘未净者复发率较高，建议密切随诊，可以术后给予辅助治疗。

Clinical analysis for 12 cases of severe vulvar intraepithelial neoplasm

Objective To study the clinical characteristics, diagnosis, treatment and its effectiveness of vulvar intraepithelial neoplasm Ⅲ(VIN Ⅲ).Methods Clinical data, including age of the patients, mode of surgical operation, pathological features, results of post-operation follow-up, of 12 cases of VIN Ⅲ admitted to the Peking Union Medical College Hospital(PUMCH)during January 1984 to December2006 were retrospectively analyzed.Results Mean age of the 12 cases was 40.3(ranging from 23 to 56)years.All the patients had symptoms of vulvar itching, three with VUlVar ulcer and one with vulvar pain.There was single neoplasm focus in two cases and multiple focuses in 10 cases, five cases with neoplasm in other sites and five with human papilloma virus(HPV)infection.All the 12 patients received surgical operation, three with simple vulvectomy(one with some residue at perianal incisal edge)and other nine with lumpectomy(four with some residue at incisal edge).Eight cases were followed-up for 9.0 months in average(ranging 1～22 months)after surgical operation, including three with some residue at incisal edge.Relapse was found in two cases three and 11 months after operation, respectively, who received re-operation, including one with residue at incisal edge and one without residue.Conclusions It is necessary to attach more importance to biopsy for the cases of suspected VIN Ⅲ, as well as colposcopic diagnosis for those with vaginal or vulvar neoplasm and testing for HPV infection.Surgical operation, including simple vulvectomy and lumpectomy with or without adjunctive measures, are main treatment for patients of VIN Ⅲ and follow-up is also important for all those with VIN Ⅲ.