反复发作的幼女外阴阴道炎病因与治疗方法探讨

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。

Study on causes and treatment of repeated vulvovaginitis in girlhood

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 < or = 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 suffering from non-specific vulvovaginitis and vulval ulcer accepted external lotion, antibiotic ointment or combining with antibiotics. Patients suffering 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.