子宫切除术后残端阴道上皮内瘤变临床分析

摘要

Objective To analyze the clinical features of vaginal intraepithelial neoplasia (VAIN) after hysterectomy. Methods The clinical data of 43 patients with VAIN after hysterectomy admitted in Zhejiang Cancer Hospital from January 2008 to December 2013 were col ected. The underlying diseases, clinical characteristics, human papil oma virus ( HPV) infection, diag-nosis,treatments and prognosis were retrospectively analyzed. Results The underlying diseases included cervical intraepithelial neoplasia (CIN,17/43, 39.5%) ,cervical cancer (CC,24/43,55.8%) uterine myoma (1 case) and uterine endometrial carcinoma (1 case).The average interval of the VAIN after hysterectomy was 21 months.Twenty four cases (55.8%) had no clinical symptoms, 13 cases (30.2%) had vaginal discharge, 6 cases (14.0%) had vaginal burn- like pain. The lesions were located in the upper vagina mostly (34/43, 79.1%). Thirty eight patients underwent HPV screening and 35 had high risk HPV infection with a detective rate of 92.1%, including 30 cases (69.8%) with positive results in both courses of disease. Forty patients were treated with opera-tions:4 cases underwent transabdominal total vaginectomy, 7 cases underwent partly vaginal resection and 29 underwent argon high- frequency electrocautery mucosectomy. There were 2 cases (4.7%) sustained, 5 cases (11.6%) recurred, among whom 4 cases underwent mucosectomy again, none of them progressed to invasive carcinoma. Conclusion VaIN after hysterectomy is more common in CC and CIN. Injury of vaginal mucosa may be the cause for the occurrence of VaIN after hysterectomy. Argon high- frequency electrocautery mucosectomy is effective in treatment of VaIN.%目的：探讨子宫切除术后残端阴道上皮内瘤变（VaIN）的临床特点、治疗及预后。方法2008年1月至2013年12月收治子宫切除术后残端阴道VaIN 43例，对其先期疾病、临床表现、辅助检查、治疗方法及预后进行回顾性分析。结果先期疾病有宫颈上皮内瘤变17例（39.5%），子宫颈癌24例（55.8%），子宫肌瘤1例，子宫内膜癌1例。继发VaIN的中位时间为术后21个月。24例(55.8%)无临床症状，13例（30.2%）阴道分泌物增多，6例(14.0%)有阴道烧灼感。病变多位于上段阴道（34/43，79.1%）。38例行高危型人乳头状瘤病毒（HPV）检测，阳性率为92.1%（35/38），其中30例在两次病程中均为阳性。40例患者采用手术治疗：4例经腹行全阴道切除术，7例经会阴行阴道部分切除术，29例行高频氩气刀黏膜剥脱术。术后2例（4.7%）病变持续，5例（11.6%）缓解后复发，均为VaIN。4例再次行黏膜剥脱术，无一例进展为浸润癌。结论子宫切除术后残端阴道VaIN多见于子宫颈癌及宫颈上皮内瘤变，中位发病时间为术后21个月。HPV感染是其发生的主要原因，手术导致的阴道黏膜受损可能促进了VaIN的发生。高频氩气刀阴道黏膜剥脱术治疗VaIN是一种安全有效的治疗手段。