發(fā)布時間：2018-05-08 02:41

  本文選題：陰道上皮內(nèi)病變 + 臨床特點��； 參考：《浙江大學》2017年碩士論文

【摘要】：目的:探討分析近年來陰道上皮內(nèi)病變患者的臨床特點與診治方式。資料與方法:回顧性收集2007年1月至2016年12月浙江大學醫(yī)學院附屬婦產(chǎn)科醫(yī)院住院收治的555例陰道上皮內(nèi)病變患者的臨床資料,最終診斷由活檢組織病理學檢查及術(shù)后組織病理學檢查中級別最高的組織學診斷而定,對患者的一般情況、臨床癥狀、體征、輔助檢查、診斷及治療方式等情況進行分析。統(tǒng)計方法采用SP5S 20.0軟件,使用t檢驗、Kruskal-Wallis檢驗和χ2檢驗進行統(tǒng)計學分析。結(jié)果:(1)555例陰道上皮內(nèi)病變患者年齡為16-78歲,中位數(shù)年齡為53.00歲。(2)555例患者最終診斷為低級別陰道上皮內(nèi)病變(陰道LSIL)192例(34.59%),高級別陰道上皮內(nèi)病變(陰道HSIL)360例(64.86%),陰道癌3例(0.54%)。(3)555例患者中,無臨床癥狀者340人(61.26%),首要臨床癥狀為異常陰道流血者134人(24.14%),陰道分泌物異常27人(4.86%);婦科檢查有異常發(fā)現(xiàn)者343人(61.80%),其中陰道異常121人(35.28%),陰道病變位于陰道穹窿或陰道殘端處71人(58.68%),陰道病變位于陰道上1/3處患者13人(10.74%)。(4)病例資料中有HPV檢測結(jié)果記錄者477人,其中HPV陽性450人(94.34%),陰道LSIL及≥陰道HSIL兩組之間高危型HPV陽性率無顯著性差異(χ2=0.018,P=0.892)。HC-Ⅱ及Cervista檢測結(jié)果對≥陰道HSIL病變的診斷靈敏度分別為92.57%、95.24%,特異度均低。(5)病例資料中有TCT檢查結(jié)果記錄者502人,陰道LSIL組患者TCT檢查結(jié)果主要為LSIL(30.86%),其次為ASC-US(28.57%);陰道HSIL組患者TCT檢查結(jié)果主要為HSIL(31.48%),其次為LSIL(19.44%)。陰道LSIL及≥陰道HSIL兩組之間TCT檢查結(jié)果無顯著性差異(χ2=1.086,P=0.297)。TCT檢查對≥陰道HSIL病變的診斷靈敏度為86.85%,特異度為16.57%,陽性預測值為66.05%,陰性預測值為40.28%。(6)病例資料中有陰道鏡檢查結(jié)果記錄者548人,陰道LSIL、陰道HSIL及陰道癌三組患者的陰道鏡檢查診斷不足率分別為73.54%、78.93%、100%,三組之間陰道鏡檢查結(jié)果具有顯著性差異(P=40.128,P=0.000)。(7)陰道LSIL、陰道HSIL、陰道癌三組患者合并宮頸病變例數(shù)及比例分別為134例(69.79%)、262例(72.78%)、3例(100.00%),三組之間無顯著性差異(χ2=1.922,P=0.750)。555例陰道上皮內(nèi)病變患者中,13例患者(2.34%)合并外陰病變。(8)555例陰道上皮內(nèi)病變患者中,371例患者(66.85%)采用手術(shù)治療,148例患者(26.67%)采用非手術(shù)治療,34例患者(6.13%)采用隨訪觀察。陰道LSIL組、陰道HSIL組、陰道癌組患者手術(shù)治療率分別為51.56%、74.72%、100.00%,三組之間手術(shù)治療率具有顯著性差異(χ2=36.199,P=0.000)。在371例接受手術(shù)治療的患者中,陰道LSIL、陰道HSIL及陰道癌三組患者術(shù)后組織病理學檢查結(jié)果較術(shù)前活檢組織病理學檢查結(jié)果升級率分別為28.28%、29.74%、100.00%,三組之間具有顯著性差異(χ2=14.748,P=0.005)。結(jié)論:(1)陰道上皮內(nèi)病變多數(shù)無特殊臨床癥狀,常并存宮頸病變,應(yīng)重視對宮頸病變患者行陰道檢查。(2)高危型HPV檢測及陰道脫落細胞學檢查對輔助診斷陰道上皮內(nèi)病變有一定的臨床價值。(3)陰道鏡檢查對診斷陰道上皮內(nèi)病變的準確性較差,應(yīng)對可疑病變者及時行活檢組織病理學檢查。(4)手術(shù)是高級別陰道上皮內(nèi)病變患者的主要治療方式。
[Abstract]:Objective: To explore the clinical features and methods of diagnosis and treatment of the patients with intraepithelial lesion of vagina in recent years. Data and methods: the clinical data of 555 cases of vaginal intraepithelial lesions admitted in the hospital affiliated to the Department of Obstetrics and Gynecology, Zhejiang University Medical College from January 2007 to December 2016 were collected, and the final diagnosis was made by biopsy histopathological examination and operation. The highest level of histology in the post histopathological examination was determined, and the general situation, clinical symptoms, signs, auxiliary examination, diagnosis and treatment were analyzed. The statistical method was SP5S 20 software, t test, Kruskal-Wallis test and chi 2 test were used for statistical analysis. Results: (1) 555 cases of vaginal epithelium The age of the patients was 16-78 years and the median age was 53 years. (2) 555 patients were finally diagnosed as low grade vaginal intraepithelial lesion (vaginal LSIL) in 192 (34.59%), high grade vaginal intraepithelial lesion (vaginal HSIL) in 360 cases (64.86%), 3 (0.54%) of vaginal carcinoma (0.54%). (3) no clinical symptom 340 (61.26%), the primary clinical symptoms were different. 134 people (24.14%) with abnormal vaginal bleeding, 27 (4.86%) with abnormal vaginal discharge, 343 (61.80%) with abnormal gynecologic examination, 121 (35.28%) of vagina abnormality, 71 in vaginal dome or vaginal stump (58.68%), and 13 (10.74%) in the vagina at 1/3. (4) cases with HPV test results There were 477 people, of which 450 were HPV positive (94.34%), and there was no significant difference in the positive rate of high risk HPV between groups of vaginal LSIL and HSIL two (P=0.892).HC- II and Cervista detection results were 92.57%, 95.24% and low specificity, respectively. (5) 502 of the case data were recorded by TCT. The results of TCT examination in the vaginal LSIL group were mainly LSIL (30.86%), followed by ASC-US (28.57%), and the results of TCT in the HSIL group of the vagina were mainly HSIL (31.48%), followed by LSIL (19.44%). There was no significant difference between the vaginal LSIL and the TCT vaginal HSIL two groups. For 86.85%, the specificity was 16.57%, the positive predictive value was 66.05%, the negative predictive value was 40.28%. (6) with the colposcopy record 548, the vagina LSIL, the vaginal HSIL and the vaginal carcinoma three groups were 73.54%, 78.93%, 100%, respectively (P =40.128, P=0.000). (7) the number and proportion of vaginal LSIL, vaginal HSIL, vaginal cancer combined with cervical lesions were 134 cases (69.79%), 262 cases (72.78%), 3 cases (100%), there was no significant difference between the three groups (chi square 2=1.922, P=0.750) in.555 cases of vaginal intraepithelial lesions, 13 patients (2.34%) with vulvar lesions. (8) 555 cases of vaginal epithelium. Of the patients, 371 patients (66.85%) were treated with surgical treatment, 148 patients (26.67%) were treated with non operative treatment and 34 patients (6.13%) were followed up. The surgical treatment rate of vaginal LSIL group, vaginal HSIL group, and vaginal cancer group was 51.56%, 74.72%, 100%, respectively (x 2=36.199, P=0.000). In 3, the rate of surgical treatment was significantly different (x 2=36.199, P=0.000). Among the 71 patients receiving surgical treatment, the postoperative histopathological examination results of vaginal LSIL, vaginal HSIL and vaginal carcinoma were 28.28%, 29.74%, 100%, respectively, compared with the preoperative biopsy histopathological examination (x 2=14.748, P=0.005). Conclusion: (1) most of the intraepithelial lesions of the vagina have no special presence. The symptoms of the cervix often coexist with cervical lesions, and should pay attention to the vaginal examination of the patients with cervical lesions. (2) high risk HPV detection and vaginal exfoliative cytology have certain clinical value for the auxiliary diagnosis of vaginal intraepithelial lesion. (3) the accuracy of the colposcopy for the diagnosis of vaginal intraepithelial lesions is poor, and the biopsy tissue should be done in time for those who are suspicious of the disease. Pathological examination. (4) surgery is the main treatment for patients with high-grade vaginal intraepithelial lesions.

【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.34

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