高强度聚焦超声治疗外阴上皮内非瘤样病变110例临床疗效评价

Efficacy of High-intensity Focused Ultrasound in the Treatment of Vulvar Non-neoplastic Epithelial Disorders

目的观察高强度聚焦超声治疗外阴上皮内非瘤样病变的临床疗效及副反应。方法2007年7月～2008年12月,对212例经外阴多点活检病理证实为外阴上皮内非瘤样病变者,根据年龄、病程及病理类型按照不平衡指数最小的分配原则分为超声组(n=106)和药物组(n=106)。超声组采用高强度聚焦超声连续直线扫描,治疗功率3.5W,时间20～30min;药物组选用我院自制的复方白斑膏治疗,硬化苔癣型37例及混合型10例给予2%丙酸睾酮软膏与复方白斑膏交替使用共6个月。治疗期间及疗程结束6个月外阴多点活检,进行疗效评估。结果治疗后6个月,根据皮肤的组织学分期和临床评分表,对病损部位皮肤弹性、色泽、病损范围占外阴部的百分比进行综合评价。超声组随访97例,治愈32例(33.0%),显效62例(63.9%),无效3例(3.1%),有效率为96.9%(94/97)。药物组随访94例,治愈4例(4.3%),显效55例(58.5%),无效35例(37.2%),有效率为62.8%(59/94)。二者比较差异有显著性(MannWhitneyU检验,Z=-6.965,P=0.000)。超声组2例外阴皮肤浅Ⅱ度烧伤,药物对症治疗后痊愈。结论高强度聚焦超声能够在短时间内缓解瘙痒症状,安全,疗效确切,是治疗外阴上皮内非瘤样病变的首选方法。

Objective To observe the efficacy and side effects of vulvar non-neoplastic epithelial disorders with focused ultrasound therapy.Methods Totally 212 cases of vulvar non-neoplastic epithelial disorders confirmed by pathology were divided into focused ultrasound treatment group（n=106）and drug therapy group（n=106）according to the principle of minimum distribution imbalance index.Ultrasound treatment group were treated with a continuous line of high-intensity focused ultrasound scanning with a treatment power of 3.5 W for 20 to 30 min.Meanwhile,the drug therapy group alternately received self-made traditional Chinese medicine cream and 2% acid testosterone ointment daily for 6 months.The patients were regularly followed up for 6 months to observe the curative effect and side effects by vulva biopsy.Results Based on the histology and clinical rating scale,the skin elasticity,skin color,percentage of the lesion area,and histological stage of the patients were evaluated.In the ultrasound group,97 patients were followed up,32 of them（33.0%）were cured,62 cases（63.9%）were improved,and 3（3.1%）failed（total effctive rate：96.9%）.In the drug group,94 patients were followed up,4 cases（4.3%）were cured,55 patients（58.5%）were improved,and 35（37.2%）failed（total effective rate：62.8%）.The difference was statistically significant between the outcomes of the two groups（Mann Whitney U test：Z=-6.965,P=0.000）.In the Focused ultrasound group,two cases developed superficial Ⅱ degree burns of the vulvar skin,which was healed in three months.Conclusion High-intensity focused ultrasound treatment can be the first choice for non-neoplastic epithelial disorders of the vulva owing to its effectiveness and safety.