Herod J J, Shafi M I, Rollason T P, Jordan J A, Luesley D M
Academic Department of Obstetrics and Gynaecology, City Hospital NHS Trust, Birmingham, UK.
Br J Obstet Gynaecol. 1996 May;103(5):446-52. doi: 10.1111/j.1471-0528.1996.tb09771.x.
To investigate the long term outcome of patients with vulvar intraepithelial neoplasia.
A retrospective study using information obtained from patient casenotes.
One hundred and thirty-three women with a primary diagnosis of vulvar intraepithelial neoplasia (VIN), identified during a 15-year period.
The diagnosis of vulvar intraepithelial neoplasia increased throughout the study period. Human papilloma virus changes were noted in 104 patients (78%); these women were significantly younger than those without (P < or = 0.001). Nineteen (14%) were managed by observation or medical treatment and the remainder by surgical methods. Histological or symptomatic recurrence after surgical treatment occurred in 55 (48%). When disease recurred, it usually did so within four years of treatment. Recurrence was more common following laser vapourisation than after local excision (75% vs 40%; P < or = 0.01). Progression to invasive disease occurred in nine patients (7%), none of whom were in the group being observed. Four deaths occurred in this group, three from gynaecological malignancies of the lower genital tract.
Patients with vulvar intraepithelial neoplasia require long term follow up, and the risk of invasion may be higher than previously thought. Surgical treatment when required should be by excisional rather than ablative methods in most instances. In selected cases it is also possible to safely manage patients by more conservative methods.
研究外阴上皮内瘤变患者的长期预后。
一项回顾性研究，利用从患者病历中获取的信息。
133名在15年期间被初步诊断为外阴上皮内瘤变（VIN）的女性。
在整个研究期间，外阴上皮内瘤变的诊断数量有所增加。104名患者（78%）检测出人乳头瘤病毒改变；这些女性比未检测出的女性明显更年轻（P≤0.001）。19名患者（14%）采用观察或药物治疗，其余患者采用手术方法。手术治疗后组织学或症状复发的有55名患者（48%）。疾病复发通常发生在治疗后的四年内。激光汽化术后复发比局部切除术后更常见（75%对40%；P≤0.01）。9名患者（7%）进展为浸润性疾病，其中没有患者处于观察组。该组有4例死亡，3例死于下生殖道妇科恶性肿瘤。
外阴上皮内瘤变患者需要长期随访，浸润风险可能比之前认为的更高。大多数情况下，必要时手术治疗应采用切除而非消融方法。在某些特定病例中，采用更保守的方法也可安全地治疗患者。
