本文選題：陰道上皮內(nèi)瘤變 + 人乳頭瘤病毒��； 參考：《實(shí)用婦產(chǎn)科雜志》2017年06期

【摘要】：目的:探討宮頸癌及高級(jí)別宮頸上皮內(nèi)瘤變(CINⅡ及以上,簡(jiǎn)稱CINⅡ+)子宮切除術(shù)后陰道上皮內(nèi)瘤變(VaIN)的臨床特點(diǎn)、診斷及治療。方法:回顧性分析收治的宮頸癌及CINⅡ+術(shù)后門診規(guī)律隨訪時(shí)經(jīng)陰道鏡下活檢發(fā)現(xiàn)的88例VaIN患者(VaINⅠ55例,VaINⅡ23例,VaINⅢ10例)的臨床病理資料。結(jié)果:(1)88例患者中82例(93.18%)無明顯臨床癥狀。發(fā)生VaINⅠ的中位年齡(47.23歲)低于VaINⅡ+(50.75歲),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)CINⅡ+和宮頸癌術(shù)后發(fā)生VaIN的平均時(shí)間為22.01±4.13月,CINⅡ+及宮頸癌術(shù)后2年內(nèi)發(fā)現(xiàn)VaIN的比率(65.90%)高于2年及以上(34.10%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)TCT、HPV及兩者聯(lián)合篩查VaIN的敏感性分別為44.57%、69.31%、87.50%,差異有統(tǒng)計(jì)學(xué)意義(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%)。發(fā)生VaIN時(shí)HPV感染亞型與既往CINⅡ+或?qū)m頸癌時(shí)HPV感染亞型相同的VaINⅡ+所占比例(56.00%)多于VaINⅠ(17.78%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)共失訪8例(9.09%)。50例VaINⅠ患者均未治療,隨訪24例(48.00%)患者轉(zhuǎn)為正常,23例(46.00%)患者為持續(xù)VaINⅠ狀態(tài),3例(6.00%)進(jìn)展為VaINⅡ。未行治療的VaINⅡ患者7例,規(guī)律隨訪6例,無一例進(jìn)展;經(jīng)手術(shù)治療的VaINⅡ+患者24例,無一例進(jìn)展為陰道癌。1例持續(xù)的陰道或外陰上皮的中重度不典型增生,共行4次手術(shù)治療。結(jié)論:VaIN多無臨床癥狀,易漏診;隨年齡的增加,VaIN的級(jí)別較高。CINⅡ+及宮頸癌術(shù)后2年內(nèi)應(yīng)密切監(jiān)控VaIN的發(fā)生。HPV和TCT聯(lián)合篩查能提高對(duì)VaIN的診斷。檢測(cè)特定類型的HPV感染對(duì)于識(shí)別VaIN風(fēng)險(xiǎn)有一定重要性。VaINⅠ采用觀察治療可行,VaIN病變均應(yīng)嚴(yán)密隨訪。
[Abstract]:Objective: To investigate the clinical characteristics, diagnosis and treatment of vaginal intraepithelial neoplasia (VaIN) after hysterectomy for cervical cancer and high grade cervical intraepithelial neoplasia (CIN II and above, CIN II). Methods: retrospective analysis of 88 cases of VaIN patients (55 cases of VaIN I) who were detected by colposcopy biopsy in the follow-up period after the operation of cervical cancer and CIN II + operation. The clinicopathological data of VaIN II 23 cases and VaIN III 10 cases. Results: (1) 82 cases (93.18%) had no obvious clinical symptoms in 88 patients. The median age of VaIN I (47.23 years) was lower than VaIN II + (50.75 years), the difference was statistically significant (P0.05). (2) the average time of VaIN after CIN II + and cervical cancer was 22.01 + 4.13 months, CIN II + and postoperative 2 after cervical cancer operation. The ratio of VaIN (65.90%) was higher than 2 years and above (34.10%), and the difference was statistically significant (P0.05). (3) TCT, HPV and the sensitivity of combined screening VaIN were 44.57%, 69.31%, 87.50%, respectively (P0.05). (4) HPV infection: 61 cases of HPV infection in VaIN patients, 58 cases of high-risk HPV infection (95.08%). VaIN HPV sense The proportion of VaIN II + in the subtype of HPV infection (56%) was more than that of VaIN I (17.78%), and the difference was statistically significant (P0.05). (5) 8 cases (9.09%),.50 cases, VaIN I patients were not treated, 24 cases (48%) were turned to normal, 23 (46%) patients were continuous VaIN I state, 3 cases (6%) progress. For VaIN II. 7 cases of VaIN II patients who were untreated, 6 cases were followed up regularly, no progress was made; 24 cases of VaIN II + patients treated with surgical treatment, none of them progressed to the moderate and severe atypical hyperplasia of vaginal or vulvar epithelium in.1 cases. Conclusion: VaIN had no clinical symptoms and missed diagnosis; with the increase of age, VaIN grade No higher.CIN II + and 2 years after cervical cancer should closely monitor the occurrence of VaIN.HPV and TCT combined screening to improve the diagnosis of VaIN. Detection of specific types of HPV infection is of certain importance for identifying the risk of VaIN.VaIN I is feasible with observation, and VaIN lesions should be closely followed up.
【作者單位】： 中南大學(xué)湘雅二醫(yī)院;
【分類號(hào)】：R737.33

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 何s，

本文編號(hào)：2073416