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Abstract：
OBJECTIVE: High-grade vaginal intraepithelial neoplasia (VAIN) is considered to be a premalignant lesion. We conducted a 20-year retrospective observational single-center study on the effectiveness of vaginal stripping (local excision procedure) as a treatment for high-grade VAIN.
METHODS: Women diagnosed with VAIN and treated with vaginal stripping performed from 1998 to 2017 at our unit were identified using the hospital computer database. Vaginal stripping was performed for high-grade VAIN after being diagnosed by colposcopy-directed biopsies. The patients were followed every 3-6 months afterward via cytology monitoring and vaginal smear. Colposcopy-guided biopsy was repeated for high-grade abnormal cytology or persistent low-grade abnormality. The residual disease and recurrence rates were determined. Risk factors for margin positivity and residual and recurrent disease were identified. The association between margin positivity and recurrence was evaluated.
RESULTS: Excluding three women whose final histology were malignant, the follow-up smears and histology (if any) were traced in the remaining 111 women. The median follow-up time was 76 months. Twenty-one of them had persistent abnormal smears (14 high-grade lesions and seven low-grade lesions) during the year following the vaginal stripping. The residual disease rate was 18.9% (21/111). The recurrence rate was 7.2%. There were five women (4%) with procedure-related complications. History of hysterectomy was identified as a risk factor for recurrence.
CONCLUSIONS: Vaginal stripping is a valid treatment option for VAIN. High-grade VAIN post treatment recurred up to 5 years post treatment. Regular long-term surveillance is needed.
METHODS: Women diagnosed with VAIN and treated with vaginal stripping performed from 1998 to 2017 at our unit were identified using the hospital computer database. Vaginal stripping was performed for high-grade VAIN after being diagnosed by colposcopy-directed biopsies. The patients were followed every 3-6 months afterward via cytology monitoring and vaginal smear. Colposcopy-guided biopsy was repeated for high-grade abnormal cytology or persistent low-grade abnormality. The residual disease and recurrence rates were determined. Risk factors for margin positivity and residual and recurrent disease were identified. The association between margin positivity and recurrence was evaluated.
RESULTS: Excluding three women whose final histology were malignant, the follow-up smears and histology (if any) were traced in the remaining 111 women. The median follow-up time was 76 months. Twenty-one of them had persistent abnormal smears (14 high-grade lesions and seven low-grade lesions) during the year following the vaginal stripping. The residual disease rate was 18.9% (21/111). The recurrence rate was 7.2%. There were five women (4%) with procedure-related complications. History of hysterectomy was identified as a risk factor for recurrence.
CONCLUSIONS: Vaginal stripping is a valid treatment option for VAIN. High-grade VAIN post treatment recurred up to 5 years post treatment. Regular long-term surveillance is needed.
摘要：
目的：高级别阴道上皮内瘤变（VAIN）被认为是癌前病变。我们进行了一项为期20年的回顾性观察性单中心研究，研究了阴道剥离（局部切除术）作为高级别VAIN治疗的有效性。
方法：使用医院计算机数据库确定1998年至2017年在我们单位诊断为VAIN并接受阴道剥离治疗的女性。通过阴道镜定向活检诊断后，对高级别VAIN进行阴道剥离。之后每3-6个月通过细胞学监测和阴道涂片对患者进行随访。对于高级别异常细胞学或持续的低级别异常，重复阴道镜引导下的活检。确定残留疾病和复发率。确定了边缘阳性，残留和复发疾病的危险因素。评估边缘阳性与复发之间的关联。
结果：不包括3名最终组织学为恶性的女性，随访涂片和组织学(如果有的话)在其余111名女性中进行了追踪.中位随访时间为76个月。在阴道剥离后的一年中，其中有21例持续存在异常涂片（14例高级别病变和7例低级病变）。残留病发率为18.9%(21/111)。复发率为7.2%。有5名女性（4％）患有手术相关并发症。子宫切除术史被确定为复发的危险因素。
结论：阴道剥脱术是治疗VAIN的有效选择。高级VAIN治疗后复发直至治疗后5年。需要定期进行长期监测。
方法：使用医院计算机数据库确定1998年至2017年在我们单位诊断为VAIN并接受阴道剥离治疗的女性。通过阴道镜定向活检诊断后，对高级别VAIN进行阴道剥离。之后每3-6个月通过细胞学监测和阴道涂片对患者进行随访。对于高级别异常细胞学或持续的低级别异常，重复阴道镜引导下的活检。确定残留疾病和复发率。确定了边缘阳性，残留和复发疾病的危险因素。评估边缘阳性与复发之间的关联。
结果：不包括3名最终组织学为恶性的女性，随访涂片和组织学(如果有的话)在其余111名女性中进行了追踪.中位随访时间为76个月。在阴道剥离后的一年中，其中有21例持续存在异常涂片（14例高级别病变和7例低级病变）。残留病发率为18.9%(21/111)。复发率为7.2%。有5名女性（4％）患有手术相关并发症。子宫切除术史被确定为复发的危险因素。
结论：阴道剥脱术是治疗VAIN的有效选择。高级VAIN治疗后复发直至治疗后5年。需要定期进行长期监测。
