The data from the literature show that women undergoing a LEEP due to CIN3 have a greater risk of having subsequent high-grade anogenital intraepithelial neoplasia or cancer, and the risk is greater for vaginal cancer than for anal and vulvar cancers. It is hypothesized that the laparoscopic hysterectomy procedure may cause a higher incidence of VaIN in hysterectomized women. There are few studies addressing this issue, and they show mixed results. This study aimed to investigate the incidence of high-grade or severe VaIN in the population of women undergoing hysterectomy for CIN3 or benign uterine disease and illustrate the treatment options and follow-up. Methods: This retrospective study was conducted on 170 women who underwent a laparoscopic hysterectomy due to high-grade cervical intraepithelial neoplasia (CIN3) or benign gynecological disease. The follow-up strategy included performing a cotest and colposcopy with biopsy if necessary. The median time between primary treatment and a diagnosis of high-grade VaIN was 18 months. Results: High-grade or severe VaIN was found in eight patients after hysterectomy (4.7%). All cases of high-grade VaIN occurred in women with persistent HPV infection. The most frequent genotype was 16. Women hysterectomized due to CIN3 showed an eight-fold greater risk than women hysterectomized due to benign disease of developing high-grade VaIN. The risk of VaIN is low in women hysterectomized due to benign disease. The risk of developing VaIN is greater in women with viral persistence. Conclusion: All these elements suggest that it is a history of HPV-related disease of the lower genital tract and viral persistence, rather than hysterectomy itself, that should be considered risk factors for the development of high-grade VaIN. After hysterectomy, patients with a history of CIN should undergo annual screening with vaginal dome cytology and HPV testing.
文献数据显示，因宫颈上皮内瘤变3级（CIN3）接受宫颈环形电切术（LEEP）的女性，后续发生高级别肛门生殖道上皮内瘤变或癌症的风险更高，且阴道癌风险高于肛门癌和外阴癌。有假说认为，腹腔镜子宫切除术可能导致子宫切除女性阴道上皮内瘤变（VaIN）发生率升高。目前针对此问题的研究较少，且结果不一。本研究旨在探讨因CIN3或良性子宫疾病接受子宫切除术的女性人群中高级别或重度VaIN的发生率，并阐述治疗方案及随访策略。方法：本回顾性研究纳入170例因高级别宫颈上皮内瘤变（CIN3）或良性妇科疾病接受腹腔镜子宫切除术的女性。随访策略包括联合检测（细胞学与HPV检测）及必要时阴道镜活检。从初始治疗到诊断高级别VaIN的中位时间为18个月。结果：子宫切除术后发现8例患者（4.7%）存在高级别或重度VaIN。所有高级别VaIN病例均发生于持续HPV感染女性中，其中最常见基因型为HPV16。因CIN3行子宫切除术的女性发生高级别VaIN的风险是因良性疾病手术者的8倍。因良性疾病手术者发生VaIN的风险较低，而病毒持续感染女性的VaIN发生风险更高。结论：上述结果表明，下生殖道HPV相关疾病史及病毒持续感染应被视为高级别VaIN发生的危险因素，而非子宫切除术本身。对于有CIN病史的子宫切除术后患者，建议每年进行阴道穹窿细胞学检查及HPV检测筛查。
肿瘤(癌症)患者之家