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目的总结宫颈合并阴道上皮内病变诊断与处理的临床经验。方法对1例宫颈冷刀锥切(cold knife conization,CKC)术后反复新柏氏液基细胞学技术(thinprep cytologic test,TCT)异常患者进行多次阴道镜下宫颈及阴道壁活检,发现高级别上皮内病变,对此患者诊断过程和治疗方法进行总结分析。结果本例54岁女性,因高级别宫颈上皮内病变行CKC手术,术后仍提示反复TCT异常,高危型人乳头瘤病毒(high-risk human papilomavirus,HR-HPV)持续感染,阴道镜活检发现宫颈合并阴道高级别上皮内病变,阴道病变广泛延伸至阴道上1/3,随行腹腔镜下筋膜外全子宫切除术+双附件切除术+部分阴道切除术,术后发现仍有阴道高级别上皮内病变残留,故继续补充阴道腔内放疗。结论对于宫颈上皮内病变患者,建议常规行阴道镜下阴道壁全面检查,对可疑病变部分活检,尤其高级别宫颈上皮内病变患者。对于宫颈合并阴道高级别上皮内病变患者,尽量行全子宫切除时同时切除阴道病变,减少阴道上皮内病变残留。
Objective To summarize the clinical experience of diagnosis and treatment of cervical intravaginal intravaginal lesions. Methods Multiple colposcopic cervical and vaginal wall biopsies were performed in 1 patient with abnormal thinprep cytologic test (TCT) after cervical cold knife conization (CKC) Intraepithelial lesions, diagnosis and treatment of patients with a summary of the analysis. Results The 54-year-old woman underwent CKC surgery due to high-grade cervical intraepithelial neoplasia. Her abnormal TCT was still noticed after surgery. Persistently infected high-risk human papilomavirus (HR-HPV) Cervical combined vaginal high-grade intraepithelial lesion, vaginal lesions extended to the vagina on the 1/3, accompanied by laparoscopic total hysterectomy + double-attachment excision + partial vaginosis, postoperative found that there are still high levels of the vagina Epithelial lesions remain, so continue to add vaginal cavity radiotherapy. Conclusions For patients with cervical intraepithelial lesion, it is recommended to conduct routine colposcopic vaginal wall examination, partial biopsy of suspected lesions, especially in patients with high-grade cervical intraepithelial lesions. For cervical intravaginal high-grade intraepithelial lesion patients, try to line hysterectomy at the same time remove the vaginal lesions and reduce residual vaginal epithelial lesions.