National Women's Hospital, Auckland City Hospital, Private Bag 92024, Grafton, Auckland, New Zealand.
Best Pract Res Clin Obstet Gynaecol. 2012 Apr;26(2):175-88. doi: 10.1016/j.bpobgyn.2011.11.005. Epub 2011 Dec 20.
Vulval squamous cell carcinoma is relatively rare; however, up to 20% of women have significant vulval symptoms during their lifetime. Formal screening programmes for vulval disease have not been established. The evidence for the use of vulval cytology and vulvoscopy is reviewed. No randomised-controlled trials have compared follow-up regimens, and although a few consensus documents have been published, formal guidelines are lacking in Grade A evidence. With increasing pressure on healthcare resources, the possibility of identifying high-risk groups to optimise the use of follow up in specialist clinics is explored. Vulval disease is uncommon and there is no evidence that screening would decrease incidence. If high-risk groups can be identified, follow up should take place in specialised vulval clinics with experienced clinicians who are trained in vulval disease. Women with uncomplicated vulval conditions should be discharged to patient-initiated follow up or primary care. Central to the reduction of mortality and morbidity is increased awareness of vulval conditions among women and improved education of healthcare professionals, with particular understanding of the importance of physical examination.
外阴鳞状细胞癌相对少见；然而，多达 20%的女性在其一生中会出现明显的外阴症状。尚未建立外阴疾病的正式筛查计划。本文回顾了外阴细胞学和外阴镜检查的应用证据。没有随机对照试验比较随访方案，尽管已经发表了一些共识文件，但在 A 级证据中缺乏正式的指南。随着医疗保健资源的压力不断增加，探索确定高危人群以优化在专科诊所进行随访的可能性。外阴疾病并不常见，也没有证据表明筛查会降低发病率。如果能够确定高危人群，则应在有经验的外阴疾病培训医生的专业外阴诊所进行随访。具有简单外阴疾病的妇女应出院进行患者发起的随访或初级保健。降低死亡率和发病率的关键是提高妇女对外阴疾病的认识，并加强对医疗保健专业人员的教育，特别要了解体格检查的重要性。
