阴道上皮内瘤变与宫颈上皮内瘤变的相关性及其诊治的初步研究

目的 探讨阴道上皮内瘤变(VAIN)与宫颈上皮内瘤变(CIN)的相关性及其诊断和治疗.方法 回顾性分析35例VAIN患者的临床表现、阴道脱落细胞学、人乳头状瘤病毒(HPV)感染以及治疗方法等资料.结果患者平均年龄43.9岁.VMN Ⅰ、VAIN Ⅱ和VMNⅢ分别占52%(18/35)、34%(12/35)和14%(5/35).VAINⅢ在年龄≤40岁者和>40岁者中分别为8%(1/13)和18%(4/22).69%(24/35)有CIN病史,17%(6/35)有宫颈癌病史.CIN Ⅰ、CIN Ⅱ～Ⅲ和宫颈癌中分别有3/9、53%(8/15)和4/6发生VAINⅡ～Ⅲ.87%(13/15)的VMN Ⅰ患者高危型HPV-DNA阳性,VAIN Ⅱ和VAINⅢ中的阳性率均为100%.97%(33/34)液基薄片检测提示细胞学检查结果异常.86%(30/35)病变位于阴道上1/3.19例患者进行了治疗,其中手术切除占74%(14/19),局部用药占16%(3/19),腔内放疗占11%(2/19).9例随访者VMN病变均出现逆转.结论 VMN 临床特点与CIN相似,CIN诊断和治疗的原则也可适用于VAIN.

Analysis of diagnosis and treatment of vaginal intraepithelial neoplasia and correlation to cervical intraepithelial neoplasia

Objective To investigate the diagnosis and therapy of vaginal intraepithelial neoplasia (VAIN) and correlation to cervical intraepithelial neoplasia (CIN). Methods The clinical and pathological data about age, liquid-based cytology, human papillomavirus (HPV) DNA test, colposcopy,histology types and treatment in 35 patients with VAIN were reviewed to investigate the diagnosis and therapy of VAIN and correlation to CIN. Results Mean age at presentation was 43.9 years. The percentage of VAIN I, VAINⅡ and VAINⅢ were 52% (18/35), 34% (12/35) and 14% (5/35), respectively. 8% (1/13) of patients were younger than 40 years developed VAIN Ⅲ, while 18% (4/22) patients were eider than 40 years. There were 83% (29/35) cases were diagnosed from 2007 to June 2008. 69% (24/35) or 17% (6/35) cases had the history of CIN or cervical cancer, respectively. VAIN Ⅱ - Ⅲ accounted for 3/9, 53% (8/15) and 4/6 of CIN I , CIN Ⅱ - Ⅲ and cervical cancer, respectively. There were 87% (13/15) positive high risk HPV infection in VAIN Ⅰ , while 100% in VAIN Ⅱ and VAINⅢ. There were 97% (33/34) cases with abnormality for liquid-based cytology and 86% (30/35) cases of lesions were located in the upper 1/3 vagina. Among 19 cases received therapy, 14 eases (74%) were treated by surgery, 2 eases (11%) by brachytherapy, 3 cases (16%) used drug on the surface of vagina and the lesions were shown recovery in 9 cases followed up. Conclusion The clinical characteristics of VAIN are similar to CIN and the principles of diagnosis and treatment are also the same as that of CIN.