阴道上皮内瘤变28例临床分析

目的: 探讨阴道上皮内瘤变(VAIN)的临床特点、危险因素、诊治及预后。方法: 回顾性分析北京协和医院2005-2011年住院收治VAIN病例28例临床资料。其中VAINⅡ7例，VAINⅢ21例。结果: 患者年龄29～76岁(中位年龄48岁)。绝经21例(75%)。26例(93%)无临床症状。25例(89%)病变位于阴道顶端。27例进行超薄液基细胞学涂片(TCT)检查异常。23例人乳头瘤病毒(HPV)检测阳性。15例有子宫切除术史，其中因宫颈上皮内瘤变(CIN)和宫颈癌切除子宫10例。子宫切除术后至诊断VAIN时间：宫颈疾病平均3.1年，非宫颈疾病8.8年。不同级别VAIN在年龄、子宫切除原因、目前及既往合并宫颈疾病、TCT结果差异无统计学意义。28例全部进行手术治疗，3例术后复发。结论: HPV病毒感染、宫颈病变、宫颈病变或宫颈癌行子宫切除术史是VAIN的危险因素;细胞学-阴道镜-组织病理学适用于VAIN的诊断及随诊;宫颈病变切除子宫治疗后应密切随访，尤其是术后3年内应警惕VAIN。　　

Clinical analysis of 28 cases of vaginal intraepithelial neoplasia

Objective:To investigate the clinical characteristics，risk factors，diagnosis and treatment，prognosis of vaginal intraepithelial neoplasia(VAIN). Methods:A retrospective study was made of 28 patients with VAIN，who were hospitalized at Peking Union Medical College Hospital between 2005 and 2011Those patients’ clinical characteristics，liquid based cytology，human papillomavirus(HPV) test，correlation to previous hysterectomy and cervical intraepithelial neoplasia，diagnosis and treatments are analyzed respectively. Results: The patients ranged from 29 to 76(median 48)years old 26 cases shown specific clinical manifestation，in 25 patients the VAIN lesions were located in the upper of the vagina，27 cases had abnomal cytology，23 patients had positive HPV infection.15 cases had a history of hysterectomy，10 of them were cervical intraepithelial neoplasia or invasive cervical cancer.The average interval of the VAIN occurrence after hysterectomy with or without cervical disease was 3.1 years and 8.8 years respectively.10 patients were accompanied with cervical intraepithelial neoplasia and cervical cancer.There were no different significant between VAINⅡ and VAINⅢ in age，hysterectomy，accompanied cervical disease，TCT.All cases were treated by surgery，3 cases recurred. Conclusions: Human papillomavirus infection，cervical intraepithelial neoplasia and cervical cancer，previous hysterectomy due to CIN/cervical cancer were risk factors of VAIN.Cytology(HPV DNA test) colposcopic biopsies pathological diagnosis are very important in diagnosis and follow up for vaginal intraepithelial neoplasia，after the treatment of CIN/cervical cancer，strict follow up are needed，especially the first 3 years.