【摘要】 目的：通过对子宫颈高级别鳞状上皮内病变(HSIL)经冷刀锥切术(CKC)或环形电切术(LEEP)治疗后，发生阴道壁病变和子宫颈病变患者的临床特征进行对比，探讨筛查新思路。方法：回顾性分析2022年1月—2023年12月来江西省妇幼保健院因子宫颈HSIL行CKC或LEEP后行阴道镜评估的患者共4 940例，共发现子宫颈和/或阴道壁病变患者460例，分析子宫颈鳞状上皮内病变(CIN)和阴道上皮内瘤变(VaIN)的临床特征。结果：460例病变患者中，单纯VaIN 126例，VaIN合并CIN92例，单纯CIN 242例。单纯CIN组及VaIN合并CIN组的高级别上皮内病变+恶性病变发生率(25.21%、18.48%)显著高于单纯VaIN组(1.59%)，差异有统计学意义(P<0.05)。筛查效能方面，三组患者中HPV检测阳性率(单纯VaIN组86.67%、VaIN合并CIN组83.72%、单纯CIN组85.65%)均高于对应组细胞学检测阳性率(单纯VaIN组68.33%、VaIN合并CIN组76.74%、单纯CIN组64.57%)；细胞学与HPV联合检测阳性率(单纯VaIN组94.17%、VaIN合并CIN组97.67%、单纯CIN组97.31%)均高于对应组单独HPV检测，三组的三种筛查方式对比差异均有统计学意义(P<0.05)。单纯VaIN组HPV多重感染率(69.23%)显著高于其余两组，单纯VaIN1 HPV阳性患者的多重HPV感染率及非HPV16/18型感染发生率均高于单纯CIN1 HPV阳性患者，差异有统计学意义(P<0.05)。结论：子宫颈HSIL患者接受CKC或LEEP治疗后，仍有可能发生子宫颈或阴道壁病变，甚至癌变，因此，此类术后患者需要进行规范的随访。细胞学与HPV联合筛查可显著提高术后病变检出效率。临床随访中应重视下生殖道评估，尤其对非HPV16/18型的多重感染患者，需重点排查阴道壁病变，避免漏诊。更多还原

【Abstract】 Objective:To compare the clinical features of patients with cervical high-grade squamous intraepithelial lesions (HSIL) who had vaginal wall lesions and cervical lesions after cold knife conization (CKC) and loop electrosurgical excision procedure (LEEP),and to explore new ideas for screening.Method:From January 2022 to December 2023,4,940 patients underwent colposcopy evaluation at Jiangxi Maternal and Child Health Hospital after CKC or LEEP for cervical HSIL,and 460 patients with cervical and/or vaginal wall lesions were found.The clinical characteristics of cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia (VaIN) were analyzed.Result:Among the 460 patients with lesions,126 had simple VaIN,92 had VaIN combined with CIN,and 242 had simple CIN.The incidence of high-grade intraepithelial lesions + malignant lesions in the simple CIN group and the VaIN combined with CIN group (25.21%,18.48%) was significantly higher than that in the simple VaIN group (1.59%),the difference was statistically significant (P<0.05).In terms of screening efficacy,the positive rates of HPV testing among the three groups of patients (86.67% in the simple VaIN group,83.72% in the VaIN combined with CIN group,and 85.65% in the?simple CIN group) were all higher than the corresponding positive rates of cytology testing (68.33% in the simple VaIN group,76.74% in the VaIN combined with CIN group,and 64.57% in the simple CIN group).Additionally,the positive rates of combined cytology and HPV testing (94.17% in the simple VaIN group,97.67% in the VaIN combined with CIN group,and 97.31% in the simple CIN group) were all higher than the positive rates of standalone HPV testing in their respective corresponding groups.The differences among the three screening methods within the three groups were statistically significant (P<0.05).The HPV multi-infection rate in the simple VaIN group (69.23%) was significantly higher than that in the other two groups,the multi-HPV infection rate and the incidence of non-HPV16/18 type infection in patients with simple VaIN1 HPV positivity were higher than those in patients with simple CIN1 HPV positivity,the differences were statistically significant (P<0.05).Conclusion:After undergoing CKC or LEEP treatment for patients with HSIL of the cervix,there is still a possibility of developing cervical or vaginal wall lesions,or even cancer.Therefore,such postoperative patients need to undergo regular follow-up.The combined cytology and HPV screening can significantly improve the efficiency of detecting postoperative lesions.In clinical follow-up,the assessment of the entire lower reproductive tract should be emphasized,especially for patients with multi-infection of non-HPV16/18 type,and vaginal wall lesions need to be carefully screened to avoid missed diagnosis.更多还原