摘要
目的·探讨全子宫切除术后,阴道残端薄层液基细胞学检测(TCT)和高危型人乳头瘤病毒(Hr-HPV)检测结果与阴道上皮内瘤样病变(VAIN)的关系。方法·收集因宫颈及非宫颈因素进行全子宫切除手术的患者6 708例(排除肿瘤患者),分析术后阴道残端病变患者TCT及Hr-HPV检测结果,以及Hr-HPV感染与阴道镜活检组织病理学结果的关系。结果·术后随访TCT和Hr-HPV并行阴道镜下病理活检提示有阴道残端病变的患者56例,其中宫颈因素全子宫切除者占5.81%(45/775),非宫颈因素全子宫切除者占0.19%(11/5 933),差异具有统计学意义(P=0.000)。56例阴道残端病变患者中,Hr-HPV感染者40例(占71.43%),未感染者16例(占28.57%)。因宫颈因素切除子宫和非宫颈因素切除子宫的患者,其Hr-HPV感染率分别为80.00%(36/45)和36.36%(4/11),差异有统计学意义(χ~2=6.248,P=0.012);TCT结果显示鳞状上皮内病变发生率分别为42.22%(19/45)和9.09%(1/11)。结论·因宫颈因素切除子宫者Hr-HPV感染率高于非宫颈因素切除子宫者,且VAIN发病率亦高;对于全子宫切除患者,术前均需仔细评估宫颈及阴道壁的情况,术后定期行TCT和HPV检查,有助于早期发现阴道病变。
Objective·To investigate the relationship between the results of thin prep cytologic test(TCT),high-risk human papillomavirus(Hr-HPV)detection and vaginal intraepithelial neoplasia(VAIN)after hysterectomy.Methods·A retrospective study was conducted of56patients with VAIN after hysterectomy.The analysis included TCT and Hr-HPV examination,clinical data and the relationship between Hr-HPV examinenation and histopathological examination of colposcopy.Results·Postoperative follow-up of TCT and Hr-HPV parallel pathological examination showed that56patients had vaginal stump lesions,including cervical factor hysterectomy accounted for5.81%(45/775)and non cervical factor hysterectomy accounted for0.19%(11/5933).The difference was statistically significant(P=0.000).In56cases of patients with vaginal stump lesions,Hr-HPV infection were40cases(accounting for71.43%),uninfected patients were16cases(accounting for28.57%).The Hr-HPV infection rates of cervical hysterectomy and non cervical factor hysterectomy patients were80.00%(36/45)and36.36%(4/11)respectively,and the difference was statistically significant(χ2=6.248,P=0.012).TCT results showed that the incidence of squamous intraepithelial lesions were42.22%(19/45)and9.09%(1/11)respectively.Conclusion·The Hr-HPV infection rate and the morbidity of VAIN of the patients undergone hysterectomy due to the cervical lesion factors is higher than those who had none cervical lesion factors.In order to identify VAIN early,patients who have the history of hysterectomy should undergo careful evaluation of cervical and vaginal circumstance before surgery and the routine examinations of TCT and Hr-HPV in the follow-up.
作者
许颖
李柱南
陈忆
史蔚
王丽娅
吴丹
XU Ying;LI Zhu-nan;CHEN Yi;SHI Wei;WANG Li-ya;WU Dan(International Peace Maternity & Child Healthcare Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China)
出处
《上海交通大学学报（医学版）》
CSCD
北大核心
2017年第5期661-665,共5页
Journal of Shanghai Jiao tong University:Medical Science
