Vaginal intraepithelial neoplasia

　　1. Etiology

　　The etiology of vaginal intraepithelial neoplasia has not been fully understood to date. It is currently believed that HPV infection is the main factor in the occurrence of VAIN. Other possible causes include cervical or vulvar cancer treated with radiotherapy and immunosuppressive therapy, and some believe that atrophic epithelium after menopause is more prone to develop into VAIN.

　　2. Pathogenesis

　　The mucosa of the vaginal lesion may present as normal, erosive, or slightly elevated and thickened white spots. Under colposcopic observation, the lesion is flat or slightly elevated, and may be accompanied by punctate or mosaic changes. The iodine test is positive.

　　Under the microscope, the superficial layer cells may be partially or completely stratified, lose orientation, and appear atypical nuclei. The extent of the superficial layer cell lesions is classified as: lesions confined to the upper third of the epithelium are grade I (mild atypical hyperplasia), the middle and lower two-thirds are grade II (moderate atypical hyperplasia), and more than two-thirds or the entire layer are grade III (severe atypical hyperplasia/original in situ carcinoma).

　　I. Complications of vaginal intraepithelial neoplasia:Infections of the vagina and vulva can occur.

　　II. Complications of vaginal resection:

　　1. Intraoperative bleeding:Vaginal hysterectomy usually results in more bleeding than abdominal hysterectomy, and bleeding or oozing from vaginal incisions compared to abdominal surgery is a prominent issue. Prevention and treatment methods include: using an electrosurgical knife to incise the cervix vaginal mucosa, and injecting oxytocin (pitocin) 10U or 0.25ml of 1/24,000 adrenaline solution on both sides of the cervix to reduce bleeding and oozing at the local surgical incision, but it is contraindicated in patients with hypertension or coronary heart disease. In addition, bleeding can occur when handling the cardinal ligament, uterosacral ligament, uterine artery, and pelvic infundibulopelvic ligament. The preventive method requires that the surgeon have a clear understanding of the anatomical layers, each operation step must be accurate, always be vigilant against the slipping of forceps or the slipping of the knot of ligature, and strive to shorten the operation time. When suturing the vaginal wall, it is particularly important to stop bleeding at both ends of the vagina to prevent leaving an ineffective cavity; before closing the abdominal cavity, it is necessary to check all ligated residual ends and stop bleeding thoroughly; when closing the abdominal cavity, the peritoneum and vaginal wall should be sutured together to prevent the formation of an ineffective cavity between the peritoneum and vaginal wall leading to渗血.

　　2. Bladder injury:It often occurs when separating into the bladder cervical space, due to unclear anatomical layers and injury or blind separation causing injury. The operator should pay attention to the position of the bladder when performing the anterior vaginal fornix incision, recognize the cervical fascia and peritoneal reflection of the bladder, and generally use a metal catheter to explore the lowest attachment position of the bladder before making the incision, which can prevent bladder injury. If an extremely difficult case is encountered, the rectum-uterus peritoneal reflection can be opened first, the uterine sacral ligament and the main ligament can be cut off, and then the anterior peritoneal reflection can be opened, which can prevent bladder injury.

　　Vaginal epithelial neoplasia may be asymptomatic or only with increased vaginal discharge and/or contact bleeding. On physical examination, the vaginal mucosa may be normal or only slightly eroded. It should be noted that when performing gynecological examination, the speculum needs to be rotated to see the entire vaginal mucosa. Otherwise, the tissue under the speculum blade may be missed and misdiagnosed.

　　Prognosis

　　Vaginal epithelial tumor-like changes are intraductal tumors that do not metastasize and do not invade adjacent organs and tissues. There is a possibility of cure with any treatment method. General medication is more likely to recur, while laser and surgical treatment without missed lesions can cure. The treatment method and the number of lesions are risk factors for recurrence, while the level of VAIN is not closely related to recurrence.

　　1. Vaginal cytology examination, tumor marker examination.
　　2. Vaginal microscopy examination, tissue pathological examination.
　　Diagnosis relies on local lesion biopsy pathological examination. Multiple biopsies should be performed on suspicious areas, and the depth of sampling should be noted. Vaginal microscopy localization of sampling helps to improve the accuracy of pathological diagnosis.

　　Firstly, dietetic recipe

　　1. Eliminating tumor eggs

　　2 eggs, 5 wall lizards of traditional Chinese medicine, 9 grams of ophiopogon, boil with 400 grams of water. After the eggs are cooked, peel them and continue to boil, discard the medicine and eat the eggs. Take one dose every night.

　　Effects: Dissolving nodules, relieving pain, dispelling wind, and calming惊. It is suitable for qi stasis and blood stasis.

　　2. Two fresh soup

　　120 grams of fresh lotus root sliced, 120 grams of fresh reed root chopped, boiled into juice and served as tea.

　　Effects: Nourishing yin, cooling blood, removing blood stasis, and stopping bleeding. It is suitable for those with excessive menstrual flow and blood heat stasis.

　　3. Silver ear and lotus root starch soup

　　Silver ear 25 grams, lotus root starch 10 grams, and appropriate amount of rock sugar. After the silver ear is soaked and softened, add appropriate amount of rock sugar and simmer until soft. Then add lotus root starch and serve.

　　Effects: It has the effects of clearing heat, moistening dryness, and stopping bleeding. It is suitable for those with excessive menstrual flow and bright red blood.

　　Secondly, what should patients with vaginal epithelial neoplasia eat?

　　1. It is advisable to consume more antitumor foods, such as sesame, almond, wheat, barley, loofah, black-bone chicken, cuttlefish, amphisbaena, porcine pancreas, chrysanthemum, umeboshi, peach, lychee, spurge, chicken blood, eel, abalone, crab, tetrodotoxin, sardine, clam, tortoise shell.

　　2. It is advisable to consume sheep's blood,螺狮, clam, cuttlefish, shepherd's purse, lotus root, mushroom, malan head, stone ear, huzi, persimmon cake.

　　3. It is advisable to consume eel, clam, water snake, needlefish, carp,麒麟菜, celery, sesame, buckwheat, rapeseed, Chinese toon, red bean, mung bean.

　　4. To enhance physical fitness and prevent metastasis, eat Tremella, Auricularia,香菇, Hericium, chicken gizzards, sea cucumber, Coix seed, walnut, crab, Erythrina variegata, Trachysaurus, needlefish.

　　Third, what is bad for the body in the diet of vaginal intraepithelial neoplasia

　　1. Avoid smoking and drinking.

　　2. Avoid comforting foods such as scallion, garlic, and pepper.

　　3. Avoid greasy, fried, and preserved foods.

　　4. Avoid warm and activating blood foods such as mutton, dog meat, leek, and pepper.

　　First, the treatment of vaginal intraepithelial neoplasia in traditional Chinese medicine

　　The treatment of this disease should be based on the characteristics of the symptoms and signs, and carry out differential diagnosis and treatment. According to the clinical manifestations of this disease, such as vaginal tumors, the symptoms are related to the unsmooth flow of Qi and blood, and damp-heat blockage, so the treatment should focus on promoting blood circulation and removing blood stasis, regulating Qi and promoting circulation, clearing heat and promoting diuresis, etc. When there are obvious large tumors, attention should be paid to the use of surgical resection for treatment, and the use of traditional Chinese medicine for functional adjustment after surgery to prevent recurrence; for multiple or small vaginal tumors, it is advisable to use traditional Chinese medicine for treatment.

　　1. Differential diagnosis and selection of formulas

　　(1) Treatment for Qi stagnation and blood stasis: Regulate Qi and promote circulation, remove blood stasis and disperse nodules. Formula: modified Wu Yao Decoction combined with Guizhi Fuling Wan: 20g of Wu Yao, 20g of Danggui, 10g of Xiangfu, 10g of Gancao, 10g of Muxiang, 20g of Guizhi, 10g of Fuling, 20g of Sanlie, 20g of Curcuma longa, 15g of Chishao. Decocted for oral administration, twice a day, one dose a day.

　　(2) Treatment for damp-heat accumulation: Clear heat and eliminate dampness, disperse nodules and remove blood stasis. Formula: modified Yinjia Decoction: 20g of Shuhua, 20g of Lianqiao, 20g of蒲公英, 10g of Zihua Dingding, 20g of Hongteng, 20g of Dqingye, 15g of Yinchen, 10g of Biejia, 15g of Puhuang, 10g of Shuhu, 10g of Jiegeng. Decocted for oral administration, twice a day, one dose a day.

　　2. Special and proven formulas

　　(1) Xiaoshuang Hui Chun Dan: 100g of煅山甲, 60g of raw water leech, 30g each of Sanlie, Curcuma longa, and Baijiezi, 20g of Rui gui. Grind all the drugs into powder, make pills with yellow beeswax, take 4.5-6g each time, take with warm water in the morning and evening, one course of treatment is 1 month, usually 1-3 courses of treatment. This formula promotes blood circulation and removes blood stasis, softens hard masses and dissipates nodules, warms the Yang and promotes new growth.

　　(2) Xiaoliu Wan: Danggui, Chishao, Ruixiang, Hai Zao, Kunnan, Xiacucao, Sanlie, Curcuma longa, Danggui, Yuanhu, Xiangfu, etc., are mixed in equal proportions to make pills. Take 4 pills, three times a day. One course of treatment is 3 months. This formula promotes blood circulation, breaks blood stasis, and removes tumors. It is used to treat benign tumors of the female reproductive organs.

　　3. Other therapies

　　(1) Sprinkling method: Use a mixture of Catechu, Niter, and Limestone to grind into a fine powder and sprinkle into the vagina, apply the medicine every other day; this formula has the effects of detoxification, removing腐烂, and anti-tumor. It is suitable for vaginal tumors with vaginitis.

　　(2) Local tumor injection method: Take 5% Curcuma longa injection 5-10ml, inject locally into the tumor, once a day, from shallow to deep, slowly injected, avoiding leakage of the drug. This formula has the effect of anti-tumor and promoting new healing. It is suitable for the treatment of vaginal tumors.

　　4. Traditional Chinese Medicine

　　(1) Guizhi Fuling Wan: This formula promotes blood circulation and removes blood stasis, resolves masses and dissipates nodules. Take 1 pill, three times a day by mouth. One course of treatment is 2 months.

　　(2) Xiacu膏: Has the effect of regulating qi and resolving masses. Take 9-15g each time, twice a day, and take it with boiling water.

　　Second, Western Medical Treatment for Vaginal Epithelial Neoplasia

　　The vaginal epithelium develops from primitive squamous epithelium and generally has stronger disease resistance than the transitional epithelium of the cervix. Vaginal intraepithelial tumors may also have a spontaneous regression phenomenon (Bornstein, 1987). Therefore, for some young patients with mild lesions that do not require active treatment, regular cytological examination or colposcopy should be performed. The treatment methods are as follows:

　　1. Drug Treatment:Apply 5% fluorouracil ointment inside the vagina, with each dose equivalent to 1.5-2.0g of fluorouracil. A course of treatment consists of 5-6 applications, and multiple courses can be used. After each vaginal application, vaseline ointment or zinc oxide ointment should be applied to the vulva and perineum to protect the skin of the vulva. The success rate of this treatment method is about 80%.

　　2. Surgical Treatment:Especially suitable for single lesions with definite therapeutic effects. However, if the lesion is large and the excision range is wide, it may shorten the vagina. In addition, if the lesion is large, attention should be paid to hemostasis after excision to prevent the formation of hematoma. It should be especially noted that VAIN lesions occurring at the top of the vagina after total hysterectomy require special care during surgery because they are particularly close to the ureter.

　　3. Other Special Therapies

　　Carbon Dioxide Laser Treatment:CO2 laser therapy is a simple and effective treatment method. Of course, before laser therapy, the existence of invasive lesions should be excluded. If there is any suspicion, laser therapy should not be performed and surgical treatment should be given. For cases of vaginal intraepithelial tumors due to excessive keratinization of the epithelium, local chemotherapy is not sensitive or chemotherapy has failed, this method can be used for treatment. During laser therapy, the vaginal mucus should be cleaned with acetic acid first, followed by iodine solution to outline the lesions, and then low-energy laser therapy (equivalent to half the energy of treating cervical in situ carcinoma) should be used. When treating vaginal intraepithelial tumors with laser therapy, in order not to damage adjacent organs, normal saline or lidocaine can be injected into the base of the lesion to separate the epidermal layer from the subcutaneous layer, so that the depth of tissue destruction by the laser does not exceed 1mm. After treatment, sexual intercourse should be stopped until the vaginal epithelium heals. The success rate of laser therapy for vaginal intraepithelial tumors is about 80%.