Objective: To investigate the application value of vaginoscopy in the diagnosis and treatment of vaginal squamous intraepithelial lesions post hysterectomy. Methods: From May 2017 to June 2020, patients with high-risk (HR)-HPV infection and (or) cytological abnormalities after hysterectomy in Obstetrics and Gynecology Hospital Affiliated to Fudan University were examined by colposcopy, and those who were not satisfied with exposure under colposcopy were further examined by vaginoscopy. The role of vaginoscopy in the detection and treatment of occult vaginal squamous intraepithelial lesions was analyzed. Results: A total of 153 patients with HR-HPV infection and (or) cytological abnormalities, and inadequate colposcopy were enrolled in this study. The average age was (49.8±8.1) years. All cases were successfully performed vaginoscopy with no vaginal perforation, no bladder and intestinal injury. During vaginoscopy, 11 (7.2%, 11/153) cases with unclear high-grade squamous intraepithelial lesion (HSIL) boundary under colposcopy were found with clear HSIL boundary, and new HSIL was found in 23 (15.0%, 23/153) cases. According to colposcopy, there were 89 cases of normal or inflammation, 45 cases of vaginal low-grade squamous intraepithelial lesion (LSIL) and 19 cases of vaginal HSIL. According to vaginoscopy, there were 56 cases of normal or chronic inflammation, 55 cases of vaginal LSIL, 40 cases of vaginal HSIL (including 2 cases of vaginal HSIL could not exclude cancer) and 2 cases of vaginal carcinoma. There were significant difference between colposcopy and vaginoscopy (P<0.01). The missed diagnosis rate of vaginal apex blind curettage under colposcopy was 54.8%. For the 40 cases with vaginal HSIL under vaginoscopy, 15 cases were completely curettaged with vaginal endoscopic claw forceps, and 22 cases were vaporized by Versapoint. Among the 37 cases of vaginal HSIL treated by vaginoscopy, 34 cases were followed up for 6 months with 31 cases of vaginal HSIL cured. The cure rate was 91.2% (31/34), the positive rate of HR-HPV decreased from 100.0% (34/34) to 79.4% (27/34). Conclusion: For patients with inadequate exposure of vaginal apex during colposcopy posthysterectomy, vaginoscopy is helpful to detect the occult lesions in the vaginal apex, and it could also be used for the treatment of vaginal squamous intraepithelial lesions.
目的： 探讨阴道内镜在隐匿性阴道顶角高级别鳞状上皮内病变（HSIL）诊治中的应用。 方法： 采用前瞻性临床研究方法，对于2017年5月至2020年6月在复旦大学附属妇产科医院就诊的子宫全切除术后因高危型（HR）-HPV阳性和（或）细胞学异常的患者，先行阴道镜检查，对阴道镜下阴道顶角暴露不满意的患者纳入本研究，进一步行阴道内镜检查，分析阴道内镜在诊断和治疗隐匿性阴道顶角HSIL中的作用。 结果： 共有153例子宫全切除术后HR-HPV阳性和（或）细胞学异常且阴道镜检查阴道顶角暴露不充分的患者纳入本研究。患者年龄为（49.8±8.1）岁，153例患者均顺利完成阴道内镜检查，未发生阴道顶角穿孔，无膀胱、直肠损伤。153例患者中，11例（7.2%，11/153）阴道镜下HSIL边界不清，在阴道内镜检查时可见清晰的HSIL边界；23例（15.0%，23/153）阴道镜检查结果为正常和（或）阴道低级别鳞状上内病变（LSIL）的患者，阴道内镜下活检发现有HSIL（即病理升级）。阴道镜下活检（均因阴道顶角暴露不充分同时行阴道顶角盲刮活检）诊断为正常或炎症89例、阴道LSIL 45例、阴道HSIL 19例，阴道内镜下活检病理诊断为正常或炎症56例、阴道LSIL 55例、阴道HSIL 40例（包括2例不除外病变更重者）、阴道癌2例，阴道镜与阴道内镜检查结果比较，差异有统计学意义（P<0.01）；阴道镜下阴道顶角盲刮活检的漏诊率达54.8%。40例阴道内镜下见阴道残端HSIL患者中，15例用阴道内镜抓钳完全抓除，22例阴道内镜下用双极电外科系统汽化阴道病灶，3例最终选择行部分阴道壁切除术。37例阴道内镜下接受治疗的阴道HSIL患者中，34例随访满6个月，其中31例阴道HSIL消失，治愈率为91.2%（31/34），HR-HPV阳性率由治疗前的100.0%（34/34）降至治疗后的79.4%（27/34）。 结论： 对于子宫全切除术后行阴道镜检查时阴道顶角暴露不充分的患者，阴道内镜有助于暴露并发现隐匿性阴道顶角HSIL，且可同时在阴道内镜下对阴道顶角HSIL进行治疗。.