聚焦超声治疗外阴上皮内非瘤样病变的近远期疗效及其影响因素

Short and long-term efficacy of focused ultrasound therapy for vulva dystrophy

目的探讨聚焦超声治疗外阴上皮内非瘤样病变的近远期疗效及并发症,并初步分析其预后影响因素。方法选择经病理检查证实为外阴上皮内非瘤样病变患者共76例,采用聚焦超声进行治疗。术后定期随访局部瘙痒症状的改善情况,采用阴道镜检查方法观察体征的变化。结果聚焦超声治疗后平均随访28.3个月(24～60个月),有39例患者治愈(27例为鳞状上皮增生型,12例为硬化性苔癣型),总治愈率为51%(39/76),总有效率达95%(72/76),累计复发率为36%(26/72)。对复发病例在间隔一段时间后进行再次聚焦超声治疗,同样可以获得显著的临床治疗效果,18例复发后再治疗患者中,6例完全恢复正常,12例症状明显减轻或缓解。76例患者中,4例(2例鳞状上皮增生型,2例硬化性苔癣型)于治疗后2～4 h 出现治疗区皮肤少量水疱,经抗炎、对症治疗后均痊愈。另有2例(1例鳞状上皮增生型,1例硬化性苔癣型)在治疗后2周出现治疗区局部皮肤浅表溃疡,经抗炎、对症及促表皮生长等治疗3周后痊愈。76例患者经24～60个月的临床观察未发现有远期并发症。不同的麻醉方式及不同的病理类型对聚焦超声治疗效果的影响比较,差异无统计学意义(P>0.05),但病程越短、年龄越小,聚焦超声治疗的临床效果越好。结论聚焦超声用于治疗外阴上皮内非瘤样病变安全有效,无远期并发症发生。

Objective To investigate the short and long-term efficacy and complications, as well as the influential factors of focused ultrasound for the treatment of vulva dystrophy. Methods Seventy-six eligible patients with vulva dystrophy were randomized and treated with focused ultrasound between 1999 and 2002. Among them, 45 patients were with squamous hyperplasia （SH） and 31 patients were with lichen sclerosus （LS）. Colposcopic examination and biopsies were used to monitor and evaluate the changes. Statistical analysis was performed using χ^2（ McNemar χ^2） test. Results The median follow-up period was 28.3 month （range 24 months to 60 months）. Complete remission （CR） occurred in 39 of 76 patients （27 SH and 12 LS）. The cure rate was 51% at four years. The response rate was 95% （72/76）. Four of the 76 patients （2 SH and 2 IS）had slight skin burn and a few blisters around the labia 2 -4 hours after treatment. Moreover, two patients （ 1 SH and 1 LS） had superficial ulcers on the treated vulva skin two weeks after ultrasound treatment, which were cured without any complications with local anti-inflammatory drugs for 2 - 3 weeks. No other long-term side effects were found after a follow up for 24 - 60 months. The total recurrence rate at four years was 36% （26/72）, all of whom were treated again with ultrasound therapy with good results and no complications. There was no obvious difference among the different anaesthesia types and pathological types of the lesions（ P 〉 0. 05）. However, the shorter the history of the disease, the better the efficacy of the treatment. The younger the patient was, the better the efficacy of the treatment. Conclusions Vulva dystrophy can be treated with focused ultrasound effectively and safely. This approach appears to be a new promising treatment method.