联合疗法治疗女性外阴上皮内非瘤样病变临床观察

目的探讨高强度聚焦超声（HIFU）配合专用药物治疗女性外阴上皮内非瘤样病变的效果。方法将2006年1月～2011年1月在济南军区总医院妇产科就诊的女性外阴上皮内非瘤样病变376例分为两组,HIFU组75例,单独应用HIFU治疗,联合疗法组301例,采用HIFU联合局部专用药物治疗。以同期56例单纯应用传统药物治疗的同类疾病患者为对照组。设立＂外阴瘙痒评分法＂、＂外阴白色病变面积计算法＂、＂四象限比较法＂和＂四度皮肤弹性评估法＂判定疗效。结果①HIFU组与联合疗法组对控制各类外阴上皮内非瘤样病变瘙痒症状的疗效显著优于对照组（P〈0.05）,联合疗法组疗效更佳（P〈0.05）。②HIFU组与联合疗法组控制白色病变的总有效率均高于对照组（P〈0.05）。HIFU组、联合疗法组治疗后白色病变面积与本组治疗前比较显著减小（P〈0.01）。③HIFU组、联合疗法组符合外阴皮肤弹性不良标准的患者治疗后外阴局部皮肤弹性评分与治疗前比较差异均有统计学意义（P〈0.05,P〈0.01）,HIFU组、联合疗法组外阴局部皮肤弹性改善总有效率均显著高于对照组（P〈0.05）,联合疗法组疗效更佳（P〈0.05）。结论 HIFU联合局部专用药物治疗女性外阴上皮内非瘤样病变,对瘙痒症状、外阴局部皮肤弹性的改善及减小白色病变面积效果满意,并具有治疗方便、安全无创的优势。

A New Incorporative Therapeutic Method for Nonneoplasia Epithelial Disorders of Skin and Mucosa of Vulva

Objective To investigate a new therapeutic method of combining high intensity focused ultrasound（HIFU） with special drugs for the treatment of nonneoplasia epithelial disorders in the skin and mucosa of vulva.Methods Three hundred and seventy six patients with nonneoplasia epithelial disorders of skin and mucosa of vulva were divided into two groups： group A（75 patients treated by HIFU only） and group B（301 patients treated HIFU and drugs）.Fifty six patients with the same disease were recruited in the control group with traditional drugs treatment only.Pruritus vulvae evaluation,calculation of vulva white lesions area,four quadrant comparison method,and four degree skin flexibility evaluation were used to assess the clinical effect.Results ①The efficacy of relieving pruritus in groups A and B was statistically more effective than the control group（P0.05）.②The total area of vulvar leucoplakia in study groups was reduced.The percentage of patient with good clinical outcome was 64.0%（48/75）and 72.1%（217/301） in group A and B,respectively,both of which were significantly better than the control group（P0.05）.③The efficacy of relieving pruritus,lichen sclerosus and vulvar leucoplakia in group B was statistically better than group A and the control group（P0.05）.Conclusion The new therapeutic method of combinging HIFU with special drugs is simple,safe,fast,effective and repeatable for the treatment of nonneoplasia epithelial disorders of skin and mucosa of vulva.