反复发作的幼女外阴阴道炎病因与治疗方法探讨

Study on causes and treatment of repeated vulvovaginitis in girlhood

目的探讨反复发作的幼女外阴阴道炎的病因与治疗方法。方法对中山大学附属第二医院近15年收治的51例年龄在10岁以下反复发作的幼女外阴阴道炎患儿的临床资料进行回顾分析。结果51例患儿中,28例为非特异性外阴阴道炎(55%),14例为后天性直肠阴道瘘(27%),5例为外阴溃疡及疖肿(10%),3例为阴道异物(6%),1例为小阴唇粘连(2%)。对其中的21例患儿行阴道分泌物病原体检测、培养,17例找到病原体,阳性率达81%,菌谱包括大肠埃希菌5例,金黄色葡萄球菌、微需氧链球菌各3例、其他菌11例。非特异性外阴阴道炎、外阴溃疡及疖肿患儿经外用洗剂、抗生素软膏,或联合全身应用抗生素,均获得治愈；后天性直肠阴道瘘患儿行瘘管切除、瘘修补术后治愈；阴道异物者取出异物后阴道炎获得治愈；小阴唇粘连者行小阴唇粘连分离术。结论非特异性外阴阴道炎是反复发作的幼女外阴阴道炎的常见类型,其主要病原菌为大肠埃希菌；针对反复发作的幼女外阴阴道炎病因的局部及全身治疗效果显著。

Objective To explore the causes and treatment of repeated vulvovaginitis in girlhood in order to improve its prevention and treatment. Methods Fifty-one girls with repeated vulvovaginitis （ age ≤ 10 years） admitted to The Second Affiliated Hospital of Sun Yat-sen University from Jan. 1990 to Nov. 2004 were reviewed retrospectively. Results We found 28 girls （55%）suffering from non-specific vulvovaginitis and 14 ones （27%） suffering from posterior recto-vaginal fistula with in 51 patients. Five girls （ 10% ） were smitten with vulval ulcer and 3 ones（6% ）had been were found with vaginal foreign bodies. One girl（2% ） was smitten with adhesion of labia minora- The vaginal discharges taken from 21 girls were cultured. Seventeen cases found bacteria. The positive rate of bacteria culture in the 21 cases reached 81% , in which, E. coli accounted for 5 cases （ 24% ）, staphylococcus and streptococcus accounted for 3 cases （ 14% ） respectively. Patients suffered from non-specific vulvovaginitis and vulval ulcer accepted external lotion, antibiotic ointment or combining with antibiotics. Patients suffered from posterior recto-vaginal fistula accepted fistulectomy. Three girls who found vaginal foreign bodies took out of foreign bodies by hysteroscope. Fifty-one girls all were cured after appropriate therapy. Conclusions Vulvovaginitis is the most common gynecologic diagnosis in girlhood. The principal cause of repeated invasion is non-specific vulvovaginitis and the secondly one is posterior recto-vaginal fistula. It need overhaul during the diagnosis. It is very availability to use hysteroscopy and do bacteria culture ＋ antibiotic sensitivity test for repeated pediatric vulvovaginitis.