CAJ | 학술논문

目的探讨外阴上皮内瘤变Ⅲ级(VINⅢ)的病因、临床病理特点、治疗方式以及预后.方法对中国医学科学院肿瘤医院1993年1月至2008年4月收治的35例VINⅢ患者的临床及病理资料进行回顾性分析.结果 35例患者均因出现临床症状而就诊,表现为外阴瘙痒及肿物;其中28例(80%)病灶呈多发性斑块,7例(20%)病灶为单发性.15例(43%)合并人乳头状瘤病毒(HPV)相关疾病.22例(63%)病理检查发现有HPV感染证据(镜检时在病变范围内发现挖空细胞).35例患者中,1例未治疗,其余34例(97%)患者接受了手术治疗,其中14例患者行肿物局部扩大切除术;另20例行单纯外阴切除术,其中4例同时行肛门周围皮肤切除术.2例切缘阳性,其中1例术后补充局部放疗.4例患者分别于术后2、4、6及22个月局部复发,分别接受了激光及手术治疗.对本组病例随访1-166个月(中位随访时间为66个月),除1例死于宫颈癌外,无一例死于本病.接受生活质量调查的26例患者中有9例(35%)术后性生活质量受到不同程度的影响,其中1例接受了外阴整形术.结论 VINⅢ的发生可能与HPV感染有关,部分患者可同时合并HPV相关疾病.本病预后良好,手术为主要治疗手段,但可能影响性生活质量.
목적 탐토외음상피내류변Ⅲ급(VINⅢ)적병인、림상병리특점、치료방식이급예후.방법 대중국의학과학원종류의원1993년1월지2008년4월수치적35례VINⅢ환자적림상급병리자료진행회고성분석.결과 35례환자균인출현림상증상이취진,표현위외음소양급종물;기중28례(80%)병조정다발성반괴,7례(20%)병조위단발성.15례(43%)합병인유두상류병독(HPV)상관질병.22례(63%)병리검사발현유HPV감염증거(경검시재병변범위내발현알공세포).35례환자중,1례미치료,기여34례(97%)환자접수료수술치료,기중14례환자행종물국부확대절제술;령20례행단순외음절제술,기중4례동시행항문주위피부절제술.2례절연양성,기중1례술후보충국부방료.4례환자분별우술후2、4、6급22개월국부복발,분별접수료격광급수술치료.대본조병례수방1-166개월(중위수방시간위66개월),제1례사우궁경암외,무일례사우본병.접수생활질량조사적26례환자중유9례(35%)술후성생활질량수도불동정도적영향,기중1례접수료외음정형술.결론 VINⅢ적발생가능여HPV감염유관,부분환자가동시합병HPV상관질병.본병예후량호,수술위주요치료수단,단가능영향성생활질량.
Objective To evaluate the etiology, clinicopathological characteristics, treatment and prognosis of VIN Ⅲ. Methods Thirty-five patients with VIN Ⅲ admitted in Cancer Hospital of Chinese Academy of Medical Sciences between 1993 and 2008 were analyzed retrospectively. Results All 35 patients attended to hospital with the symptoms of pruritus vulvae and lumps. Among of them, there were 28 (80%) cases whose lesions presented as multiple plaques, while 7 (20%) eases lesion were monofocal.Fifteen out of 35 eases had coexistent with human papillomavirus (HPV) related lesions, and there were the evidence of HPV in 22 patients whose pathologic sections revealed koilocytes. 34 cases (97%) except one received different types of surgical resections, including wide local resection (14/34), simple vulvectomy (16/34) and simple vulvectomy plus perianal skin resection (4/34), while there two cases shown positive cut-edges and one of them received radiotherapy postoperatively. Four out of the 34 cases recurred locally in 2, 4, 6 and 22 months and received surgical treatment again or laser therapy, respectively. The median follow-up period was 66 months ( range 1-166), and none of them were died of the disease itself except one case died of the concurrent cervical cancer. Among 26 cases received the investigation of the quality of life,there were nine cases (35%) suffered from sexual dysfunction after the operation, and one of them received vulvoplasty. Conclusions VIN Ⅲ has good prognosis. The development of VIN Ⅲ may be related to the infection of HPV, because most of them concurrent with HPV diseases. Its primary treatment is surgical resection, while affecting on the quality of life.