【摘要】 目的评价CO2激光气化治疗外阴和阴道上皮内瘤变的疗效。方法收集2002年3月至2012年1月在复旦大学附属妇产科医院接受外阴和/或阴道CO2激光治疗的191例外阴上皮内瘤变(vulvar intraepithelial neoplasia,VIN)和阴道上皮内瘤变(vaginal intraepithelial neoplasia,VaIN)患者的临床病理资料进行回顾性分析。结果 191例患者中VaINⅠ115例,VaINⅡ~Ⅲ41例,VINⅡ~Ⅲ39例,其中4例同时有阴道及外阴病变。患者的平均年龄(44.1±11.6)岁。平均随访时间(29.0±13.7)个月。191例患者中有133例(69.6%)同时或先后诊断为宫颈疾病病变,其中宫颈低级别上皮内瘤变占45.9%(61/133),宫颈高级别上皮内瘤变占41.4%(55/133),宫颈癌12.8%(17/133)。术后139例无复发或残留,总体治愈率为72.8%。其中VaINⅠ治愈率为72.2%,VaINⅡ~Ⅲ治愈率为61.0%,VINⅡ~Ⅲ治愈率为82.1%。VaINⅠ、VaINⅡ~Ⅲ和VINⅡ~Ⅲ患者HPV检测阳性率分别为88.4%、92.9%和84.0%,术后转阴率分别为69.7%、68.0%和85.7%,平均转阴时间分别为(1.05±0.66)年、(0.93±0.65)年和(0.99±0.70)年。结论 CO2激光气化治疗外阴和阴道上皮内瘤变是安全有效的。下生殖道癌前病变常为多中心,治疗后病变残留率较高,应定期随访监测残留和复发病变。更多还原

【Abstract】 Objective To evaluate the effectiveness of CO2 laser vaporization of vaginal intraepithelial neoplasia(VaIN)and vulvar intraepithelial neoplasia(VIN). Methods Medical records of 191 patients with VaIN and/or VIN treated by CO2 laser vaporization from Mar.,2002 to Jan.,2012 in Obstetrics and Gynecology Hospital of Fudan University were reviewed. Results Of the 191 patients,115 patients had VaINⅠ,41 patients had VaINⅡ-Ⅲ,39 had VINⅡ-Ⅲ.Among them,4patients had VaIN and VIN simultaneously.The average age was(44.1±11.6)years.The mean duration of follow-up was(29.0±13.7)months.One hundred and thirty-three patients(69.6%)had prior or concurrent cervical neoplasia or cancer.Among those patients,45.9%(61/133)had low-grade cervical intraepithelial neoplasia,41.4%(55/133) had high-grade cervical intraepithelial neoplasia,12.8%(17/133)had cervical cancer.VaIN or VIN was completely eliminated in 139(72.8%)patients after laser vaporization.The cure rate for VaINⅠ,VaINⅡ-Ⅲand VINⅡ-Ⅲwas 72.2%,61.0% and 82.1% respectively.The positive rate of HPV test in patients with VaINⅠ,VaINⅡ-Ⅲand VINⅡ-Ⅲwas 88.4%,92.9% and 84.0%respectively;69.7%,68.0%and 85.7%tested negative respectively after laser vaporization in those HPV positive VaINⅠ,VaINⅡ-Ⅲ and VINⅡ-Ⅲ patients.The average time to eliminate HPV in those patients was(1.05±0.66),(0.93±0.65)and(0.99±0.70)years. Conclusions CO2 laser vaporization was an effective method for the treatment of VaIN and VIN.However,lower gentital tract disease is often multicentric with high residual rate after treatment.All patients should be closely evaluated for persistence,recurrence or progression to cancer.更多还原