阴道上皮内瘤变诊治方法进展

阴道上皮内瘤变是包括阴道鳞状上皮不典型增生及原位癌的一组病变，是一种少见的阴道浸润癌癌前病变，与持续性人乳头瘤病毒（HPV）感染、宫颈癌前病变、宫颈癌等的发生密切相关，发病率较低。阴道上皮内瘤变多无明显临床症状，肉眼观察阴道黏膜基本正常，诊断主要依据辅助检查。与宫颈上皮内瘤变诊断的三阶梯诊断程序一致，常在宫颈癌筛查的第二阶段阴道镜检查时偶然发现，常合并宫颈上皮内瘤变。近年来随着阴道镜应用的普及和提高，阴道上皮内瘤变的检出率明显增加。阴道上皮内瘤变的治疗主要依据病变级别，阴道上皮内瘤变Ⅰ级病变可自行消退，不需要治疗，密切随访即可，但对于高危型HPV感染的患者应重视随访。阴道上皮内瘤变Ⅱ～Ⅲ级公认为癌前病变，一旦确诊需积极治疗，临床上的治疗方法有手术治疗、药物治疗、物理治疗及放疗。但至今尚无统一的临床诊疗标准方案，每种方法都有其利弊，根据患者自身情况选择治疗方案非常重要。

Advances in Diagnosis and Treatment of Vaginal Intraepithelial Neoplasia

Vaginal intraepithelial neopalsia (VAIN) is included vaginal squamous dysplasia and carcinoma in situ of a group of disease, is a rare precancerous lesions, the main risk factor is the persistent high-risk HPV virus infections, cervical intraepithelial neoplasia (CIN) and cervical cancer, the incidence of it is low. There is no obvious clinical symptom of vaginal intraepithelial neoplasia. The vaginal mucosa is basically normal and the diagnosis is mainly based on the accessory examination. Consistent with the three step diagnostic procedure for cervical intraepithelial neoplasia, it is usually found incidentally in colposcopy at the second stage of cervical cancer screening, often associated with cervical intraepithelial neoplasia. In recent years, with the popularization and improvement of colposcopy, the detection rate of vaginal intraepithelial neoplasia has increased significantly. The treatment of vaginal intraepithelial neoplasia mainly depends on the grade of the lesion. The VAINⅠgrade can be reduced by itself, without treatment and followed up closely. But the patients with high-risk HPV infection should pay attention to follow-up. VAINⅡ-Ⅲgrade is recognized as precancerous lesions, once diagnosed, the need for active treatment. The clinical treatment methods include surgical treatment, drug therapy, physical therapy and radiotherapy. But so far, there is no unified standard of clinical diagnosis and treatment. Each method has its advantages and disadvantages. It is very important to choose a treatment plan according to the patient′s own condition.