聚焦超声治疗外阴上皮内非瘤样病变900例临床疗效分析

目的 探讨聚焦超声治疗外阴上皮内非瘤样病变的临床疗效,评价聚焦超声治疗的有效性、安全性及可行性。方法 对2003年6月至2005年8月,采用聚焦超声治疗的941例外阴上皮内非瘤样病变患者的临床资料进行回顾性分析,其中鳞状上皮增生型498例（占52．9％）,硬化性苔癣型342例（占36．4％）,硬化性苔癣伴增生（混合）型101例（占10．7％）。患者年龄18～70岁,平均年龄40．8岁。平均病程为6．2年（3个月～45年）,于治疗后6、12个月评价其疗效（分为治愈、有效、无效,以治愈及有效例数计算有效率）。结果 941例患者中900例患者随访资料完整,治疗后6个月,临床治愈434例（占48．2％）,有效420例（占46．7％）,无效46例（占5．1％）,治疗后6个月的有效率为94．9％。治疗后12个月的有效率为83．7％。治疗后12个月有101例患者再次出现明显的外阴瘙痒症状（占11．2％）,再次给予聚焦超声治疗,其中90例达到临床有效。900例患者中,无一例出现阴道周围组织（尿道或直肠）损伤等并发症,但有50例患者（5．6％）在治疗中及1周后出现皮肤水泡及局部浅表溃疡,经对症治疗后全部愈合。结论 聚焦超声是当前治疗外阴上皮内非瘤样病变行之有效的新方法,值得在临床上进一步推广应用。

Treatment of nonneoplastic epithelial disorders of skin and mucosa of vulva with focused ultrasound

OBJECTIVE: To explore the clinical efficacy of focused ultrasound for patients with white lesions of the vulva, as well as its safety and feasibility. METHODS: Clinical data of 941 patients with white lesions of the vulva treated with focused ultrasound from June 2003 to December 2005 were retrospectively reviewed. The mean age of the patients was 40.8 years (18 - 70 years) and the median course of the disease was 6.2 years (3 months - 45 years). Meanwhile, pathological diagnosis was performed in all the patients before treatment, in which 498 cases were squamous hyperplasia, 342 cases were lichen sclerosus and 101 cases were lichen sclerosus with squamous hyperplasia. Patients were followed up and therapeutic effects of focused ultrasound was evaluated at 6 and 12 months after the treatment, respectively. The symptoms of pruritus in the vulva and the changes in the color and elasticity of the vulvar lesions were observed. RESULTS: Of all the patients, 900 were followed up after the treatment, and the ratio of effectiveness was 94.9%. Only 46 patients (5.1%) had no response to the therapy. Of the effective patients, 434 cases were completely cured (48.2%), and 420 cases were improved (46.7%). Pruritus of vulva recurred in 101 patients (11.2%) one year after treatment; however, these patients still had a response to the second or third treatment. CONCLUSIONS: Focused ultrasound therapy is a highly effective instrument in treatment of white lesions of the vulva. It can not only relieve the symptoms of itching, but is also helpful in recovering the color and elasticity of the vulva.