CO_(2)点阵激光治疗女性阴道松弛对盆底结构及功能的影响

Effect of CO_(2) fractional laser on the structure and function of pelvic floor in female vaginal laxity

目的:探讨CO_(2)点阵激光治疗女性阴道松弛对盆底结构及功能的影响。方法:2020年3月至2021年11月,空军军医大学第一附属医院皮肤科接诊女性阴道松弛患者28例,年龄26~59(37.5±8.3)岁。经CO_(2)点阵激光治疗仪进行阴道内微创治疗,每月1次共3次。根据治疗前后阴道横径、女性性功能评分、阴道内环境健康指数评分、阴道触觉成像系统、盆腔超声及磁共振、组织活检、患者满意度、疼痛度评分、术后不良反应等指标评估临床疗效及安全性。结果:28例患者治疗后,其中21例自觉阴道松弛相关症状改善。所有患者在治疗前、治疗后1个月各指标均有改善,阴道横径从(3.00±0.39)指降至(2.71±0.40)指(P<0.05);阴道健康指数评分从(17.12±3.97)分升至(21.69±3.61)分(P<0.05);女性性功能指数评分从(23.11±3.70)分提高至(27.43±5.33)分(P<0.05)。阴道触觉成像系统检查显示,阴道肌力及弹性均有不同程度改善,与治疗前对比差异有统计学意义(阴道前壁总收缩力t=26.23,P<0.001;阴道后壁总收缩力t=39.02,P<0.001;阴道前壁平均收缩力t=17.92,P<0.001;阴道后壁平均收缩力t=22.57,P<0.001)。13例合并轻中度压力性尿失禁的患者尿失禁评分(ICI-Q-SF量表)与治疗前比较降低[术前(8.97±2.99)分,第3次治疗1个月(7.18±1.79)分],差异有统计学意义(t=2.79,P<0.01)。盆腔超声及磁共振检查提示阴道壁结构紧致,盆腔超声观察到膀胱颈移动度降低,膀胱尿道旋转角减小,阴道组织活检提示治疗后阴道黏膜厚度增加,胶原纤维数量增加、排列更规律。所有患者治疗满意度高,且治疗过程中无感染、出血等不良反应。结论:经阴道内CO_(2)点阵激光治疗可改善阴道周围相关盆底结构及功能,治疗女性阴道松弛、压力性尿失禁、女性性功能障碍,临床疗效显著,安全性较好。

Objective To observe the changes of pelvic floor structure and function in female vaginal laxity after CO_(2) fractional laser transvaginal treatment.Methods This study reviewed the improvement of pelvic floor structure and function after CO_(2) fractional laser transvaginal treatment in 28 female patients[aged 26-59(37.5±8.3)years]with vaginal laxity syndrome seen at the Department of Dermatology,the First Affiliated Hospital of Air Force Medical University from March 2020 to November 2021.A total of 28 female patients with vaginal laxity syndrome underwent intravaginal treatment by CO_(2) fractional laser instrument once/month for 3 times.The clinical efficacy and safety were evaluated according to the pre-and post-treatment transverse vaginal diameter,FSFI score of female sexual function,VHIS score of vaginal environment,vaginal tactile imaging system(VTI),pelvic ultrasound and MRI,tissue biopsy,patient satisfaction,pain score,and postoperative adverse effects.Results Twenty-one of the twenty-eight female patients with vaginal laxity syndrome showed significant improvement in symptoms related to vaginal laxity syndrome after intravaginal treatment with CO_(2) fractional laser therapy.All patients showed improvement in all indexes before and 1 month after treatments the mean vaginal transverse diameter decreased from(3.00±0.39)fingers to(2.71±0.40)fingers(P<0.05),VHIS increased from(17.12±3.97)to(21.69±3.61)(P<0.05),FSFI score improved from(23.11±3.70)to(27.43±5.33)(P<0.05),and VTI examination showed that vaginal muscle strength and elasticity were improved to different degrees,and there was a statistical difference compared with that before treatment(total contractility of the anterior vaginal wall:t=26.23,P<0.001;total contractility of posterior vaginal wall:t=39.02,P<0.001;the mean contractility of the anterior vaginal wall:t=17.92,P<0.001;the mean contractility of the posterior vaginal wall:t=22.57,P<0.001).At the same time,questionnaire score of international consultation on incontinent questionnaire short form(ICI-Q-SF scale)of 13 patients with combined mild to moderate stress urinary incontinence showed a statistically significant decrease compared with those before treatment(8.97±2.99 before treatment and(7.18±1.79)one month after treatment;t=2.792,P<0.01).Pelvic ultrasound and magnetic resonance examination indicated a tightening of the vaginal wall structure,and pelvic ultrasound observed a significant decrease in bladder neck mobility and a significant decrease in vesicourethral rotation angle.Vaginal tissue biopsy indicated an increase in the thickness of the vaginal mucosa and an increase in the number and more regular arrangement of collagen fibers after treatment.All patients had high treatment satisfaction and there were no adverse effects such as infection and bleeding during the treatment.Conclusions Transvaginal CO_(2) fractional laser treatment can improve the pelvic floor structure and function around the vagina,treat female vaginal laxity syndrome,stress urinary incontinence and female sexual dysfunction,with significant clinical efficacy and good safety.