宫颈癌及高级别宫颈上皮内瘤变子宫切除术后阴道上皮内瘤变88例临床分析

目的:探讨宫颈癌及高级别宫颈上皮内瘤变(CINⅡ及以上,简称CINⅡ+)子宫切除术后阴道上皮内瘤变(VaIN)的临床特点、诊断及治疗。方法:回顾性分析收治的宫颈癌及CINⅡ+术后门诊规律随访时经阴道镜下活检发现的88例VaIN患者(VaINⅠ55例,VaINⅡ23例,VaINⅢ10例)的临床病理资料。结果:(1)88例患者中82例(93.18%)无明显临床症状。发生VaINⅠ的中位年龄(47.23岁)低于VaINⅡ+(50.75岁),差异有统计学意义(P0.05)。(2)CINⅡ+和宫颈癌术后发生VaIN的平均时间为22.01±4.13月,CINⅡ+及宫颈癌术后2年内发现VaIN的比率(65.90%)高于2年及以上(34.10%),差异有统计学意义(P0.05)。(3)TCT、HPV及两者联合筛查VaIN的敏感性分别为44.57%、69.31%、87.50%,差异有统计学意义(P0.05)。(4)HPV感染:61例HPV感染的VaIN患者中,高危型HPV感染58例(95.08%)。发生VaIN时HPV感染亚型与既往CINⅡ+或宫颈癌时HPV感染亚型相同的VaINⅡ+所占比例(56.00%)多于VaINⅠ(17.78%),差异有统计学意义(P0.05)。(5)共失访8例(9.09%)。50例VaINⅠ患者均未治疗,随访24例(48.00%)患者转为正常,23例(46.00%)患者为持续VaINⅠ状态,3例(6.00%)进展为VaINⅡ。未行治疗的VaINⅡ患者7例,规律随访6例,无一例进展;经手术治疗的VaINⅡ+患者24例,无一例进展为阴道癌。1例持续的阴道或外阴上皮的中重度不典型增生,共行4次手术治疗。结论:VaIN多无临床症状,易漏诊;随年龄的增加,VaIN的级别较高。CINⅡ+及宫颈癌术后2年内应密切监控VaIN的发生。HPV和TCT联合筛查能提高对VaIN的诊断。检测特定类型的HPV感染对于识别VaIN风险有一定重要性。VaINⅠ采用观察治疗可行,VaIN病变均应严密随访。

88 Cases of Clinical Analysis of Vaginal Intraepithelial Neoplasia after Hysterectomy of Cervical Cancer and High-Grade Cervical Intraepithelial Neoplasia

Objective:To investigate the clinical characteristics,diagnosis and treatment,prognosis of vaginal intraepithelial neoplasia(VaIN) after hysterectomy of Cervical cancer and high-grade cervical intraepithelial neoplasia (CIN Ⅱ +).Methods:A retrospective study was made of 88 patients with VaiN,who were diagnosed by Pathology when regular follow-up after operation of cervical cancer and CIN Ⅱ + (55 cases of VaIN Ⅰ,23 cases of VaIN Ⅱ and 10 cases of VaIN Ⅲ).Results:①Among the 88 cases with VaiN,82 cases had no obvious clinical symptoms.The median age of VaIN Ⅰ (47.23 years old) was lower than VaIN Ⅱ (50.75 years old),which had statistically significant differences(P ＜0.05).②ValN that occurred after CIN Ⅱ + and cervical cancer's operation were on an average time of 22.01-±4.13 months,and the onset ratio within 2 years(65.90％) was higher than above 2 years (34.10％),differences on the ratio was statistically significant (P ＜ 0.05).③There was statistically significant differences on the sensitivity of the detection of VaIN among with TCT,with HPV and with combining both(44.57％,69.31％ and 87.50％ respectively,P ＜ 0.05).④HPV infection:61 patients had positive HPV infection,including 58 patients with high-risk type HPV infection (95.08％).The proportion that the same subtype of HPV on CIN Ⅱ + or cervical cancer,of VAIN Ⅱ / Ⅲ (56.00％) was more than VaIN Ⅰ (17.78％),the difference was statistically significant(P ＜ 0.05).⑤80 patients had regular follow-up,and the lost to follow-up rate was 9.09％ (8 cases).50 patients with VAIN Ⅰ were no treated.24 patients(48.00％) turned into normal,23 patients(46.00％)had no change,and 3 cases(6.00％) worsen to VaIN Ⅱ.7 patients with VaIN Ⅱ were not treated.6 patients had regular follow-up of and no one worsen.24 patients with VaIN Ⅱ + were treated by surgery,and on one worsen to a vaginal carcinoma.1 case continued in VaIN or VlN,and received a total of four times of operations.Conclusions.ValN always has no clinical symptoms and is easyly misdiagnosed.With the increase of age,the higher the grade of VaIN is.Closely monitoring of the onset of VaIN should be done after two years of the treatment of cervical cancer and CIN Ⅱ +.Screening of combination TCT and HPV can improve the diagnosis of VaIN.Testing specific types of HPV has certain significance to identify risk of VaIN.VaIN Ⅰ can take expectant treatment.All the VaIN should be closely followed up.