Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, and the Obstetrics-Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts.
Obstet Gynecol. 2017 Dec;130(6):1237-1243. doi: 10.1097/AOG.0000000000002311.
To examine success rates of 5-fluorouracil, excision, and laser ablation as the initial and secondary management strategies for women with high-grade vaginal intraepithelial neoplasia.
We conducted a retrospective case series of women referred to a single center for management of biopsy-proven, high-grade vaginal intraepithelial neoplasia between April 1994 and May 2016. Data including demographic characteristics, human papillomavirus risk factors, antecedent Pap cytology, concurrent or prior cervical and vulvar dysplasia, and treatment outcome including follow-up Pap cytology were recorded. All women were counseled on options of excision, laser ablation, or 5-fluorouracil, which was administered intravaginally according to a standardized regimen. Recurrence was defined as a biopsy showing any vaginal intraepithelial neoplasia diagnosis after primary treatment.
Forty-seven patients were treated initially with 5-fluorouracil, 35 were treated with excision, and 22 were treated with laser ablation. Demographics were similar between groups. No recurrence was noted in 35 women treated with 5-fluorouracil (74%; 95% CI 62-87%), 20 treated with excision (57%; 95% CI 41-74%), and nine treated with laser ablation (41%; 95% CI 20-61%). Among 13 patients treated with 5-fluorouracil for recurrence, eight (62%) did not experience a second recurrence. Nine of 58 (16%) patients ever treated with 5-fluorouracil reported a side effect, most commonly irritation and dyspareunia.
5-fluorouracil was associated with a 74% success rate as the initial treatment modality for high-grade vaginal dysplasia. There is also a role for 5-fluorouracil in the management of recurrent or persistent high-grade vaginal intraepithelial neoplasia.
研究 5-氟尿嘧啶、切除术和激光消融术作为治疗高级别阴道上皮内瘤变女性的初始和二线管理策略的成功率。
我们对 1994 年 4 月至 2016 年 5 月间在一家中心因活检证实的高级别阴道上皮内瘤变而转诊的女性进行了回顾性病例系列研究。数据包括人口统计学特征、人乳头瘤病毒危险因素、先前的巴氏细胞学检查、同期或先前的宫颈和外阴发育不良以及治疗结果，包括随访巴氏细胞学检查。所有女性均接受过切除术、激光消融术或 5-氟尿嘧啶治疗的选择咨询，5-氟尿嘧啶根据标准化方案阴道内给药。复发定义为原发性治疗后活检显示任何阴道上皮内瘤变诊断。
47 例患者最初用 5-氟尿嘧啶治疗，35 例用切除术治疗，22 例用激光消融术治疗。各组的人口统计学特征相似。35 例接受 5-氟尿嘧啶治疗的患者中无复发（74%；95%CI 62-87%），20 例接受切除术治疗的患者中无复发（57%；95%CI 41-74%），9 例接受激光消融术治疗的患者中无复发（41%；95%CI 20-61%）。在因复发而接受 5-氟尿嘧啶治疗的 13 例患者中，8 例（62%）未再次复发。9 例（16%）曾接受过 5-氟尿嘧啶治疗的患者报告有副作用，最常见的是刺激和性交困难。
5-氟尿嘧啶作为高级别阴道发育不良的初始治疗方法，成功率为 74%。5-氟尿嘧啶在治疗复发性或持续性高级别阴道上皮内瘤变方面也有作用。
