点阵式二氧化碳激光与曲安奈德治疗外阴硬化性苔癣的对照研究  

The case study of fractional carbon dioxide laser and triamcinolone acetonide of the patients with vulvar lichen sclerosus

作　　者：李静然[1] 杨莹超[1] 谢亚静 王建六[1] LI Jingran, YANG Yingchao, XIE Yajing, WANG Jianliu.(Department of Obstetrics and Gynecology, Peking University People＇s Hospital Beijing 100044, China)

机构地区：[1]北京大学人民医院妇产科

出　　处：《中国妇产科临床杂志》2018年第2期107-110,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：中国整形美容协会专项基金(FRPR201601-01)

摘　　要：目的探讨点阵式二氧化碳（CO2）激光与曲安奈德治疗外阴硬化性苔癣（vulvar lichen sclerosus,VLS）的疗效、副作用及复发情况。方法收集2016年1月—2017年4月本院妇科门诊VLS患者63例,其中29例给予点阵式CO2激光治疗3次作为激光组;34例给予曲安奈德益康唑乳膏6周作为药物组。并采用临床症状体征评分评估患者治疗前后情况。结果两组治疗后患者瘙痒评分与治疗前比较,差异有统计学意义（P0.05）;两组治疗后患者性交痛与治疗前比较,差异有统计学意义（P〈0.05）;激光组疗程结束后6个月皮肤弹性评分与药物组比较,差异有统计学意义（P〈0.05）;激光组第1次治疗后瘙痒症状明显减轻时间[（6.86±4.21）d]少于药物组[（9.79±6.47）d]（P〈0.05）;治疗结束后6个月,激光组病变部位皲裂/皮肤黏膜瘀斑改善率（93.10%,27/29）高于药物组（74.19%,23/31）（P〈0.05）。两组患者随访时间6-19个月。激光组6例（20.69%,6/29）治疗后局部不适伴轻度充血或肿胀,均无需治疗,72 h内自然消失,无副损伤、出血、感染及溃疡等。药物组3例（8.82%,3/34）用药后外阴灼烧感、刺痛或瘙痒加重,停止用药;6例（19.35%,6/31）轻度刺激感,对症治疗好转,1例（3.23%,1/31）血管扩张,无继发感染、萎缩及色素沉着等。结论点阵式CO2激光可作为治疗外阴硬化性苔癣的方法,可明显改善瘙痒症状,与局部类固醇药物比较,改善症状较快,改善皮肤弹性稍好,但后者副作用稍多。Objective To investigate the effect, side effects and relapse of fractional carbon dioxide（CO2） laser for the treatment of vulvar lichen sclerosus（VLS）. Methods Sixty three patients with VLS were enrolled prospectively from January 2016 to December 2017 in Peking University People＇s Hospital. 29 cases were given fractional CO2 laser for 3 times as laser group. Thirty four cases were selected as the medicine group, with triamcinolone acetonide cream for 6 weeks. The score clinical symptoms and signs were used to assess the degree of symptoms and signs before and after treatment. Results The pruritus score was statistically differences between after and before treatment in two group（P 〈 0.05）. After the first treatment, there was significanly difference in pruritus score between laser group and medicine group（P 〈 0.05）, but there was no significant differences after treatment at first and sixth month（P 〉0.05）. The dyspareunia score were statistically difference between after and before treatment（P〈 0.05）. The skin elasticity score in laser group was statistically difference compared with that of the medicine group at sixth month after treatment（P〈 0.05）. The time of pruritus improvement [（6.86±4.21） d] in laser group were less than that of the medicine group [（9.79±6.47） d; P 〈0.05].The correction rate of chapped/submucosal hemorrhage in laser group [93.10%, 27/29] was higher than that of the medicine group [74.19%, 23/31; P〉 0.05]. The recovery rate of skin color（10.34%, 3/29; 3.23%, 1/31） was not statistically difference after the treatment three months in two groups（P 〈 0.05）. The follow-up time was 6-19 months. Six patients（20.69%） were mild discomfort and hyperemia or swelling in laser group without serious adverse events. Three cases（8.82%） were tingling, redness or itching, and the drug was discontinued, six cases（19.35%） with mild irritation, one case with vascular dilatation, but no other adverse reactions such as secondary ba

关 键 词：点阵式二氧化碳激光 曲安奈德 外阴硬化性苔癣 局部治疗 疗效 

分 类 号：R711.72[医药卫生—妇产科学]