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目的探讨聚焦超声治疗外阴上皮内非瘤样病变的近远期疗效及并发症,并初步分析其预后影响因素。方法选择经病理检查证实为外阴上皮内非瘤样病变患者共76例,采用聚焦超声进行治疗。术后定期随访局部瘙痒症状的改善情况,采用阴道镜检查方法观察体征的变化。结果聚焦超声治疗后平均随访28.3个月(24～60个月),有39例患者治愈(27例为鳞状上皮增生型,12例为硬化性苔癣型),总治愈率为51%(39/76),总有效率达95%(72/76),累计复发率为36%(26/72)。对复发病例在间隔一段时间后进行再次聚焦超声治疗,同样可以获得显著的临床治疗效果,18例复发后再治疗患者中,6例完全恢复正常,12例症状明显减轻或缓解。76例患者中,4例(2例鳞状上皮增生型,2例硬化性苔癣型)于治疗后2～4 h 出现治疗区皮肤少量水疱,经抗炎、对症治疗后均痊愈。另有2例(1例鳞状上皮增生型,1例硬化性苔癣型)在治疗后2周出现治疗区局部皮肤浅表溃疡,经抗炎、对症及促表皮生长等治疗3周后痊愈。76例患者经24～60个月的临床观察未发现有远期并发症。不同的麻醉方式及不同的病理类型对聚焦超声治疗效果的影响比较,差异无统计学意义(P>0.05),但病程越短、年龄越小,聚焦超声治疗的临床效果越好。结论聚焦超声用于治疗外阴上皮内非瘤样病变安全有效,无远期并发症发生。
Objective To investigate the short-term and long-term effects and complications of focused ultrasound in the treatment of non-xenogenic lesions of the vulvar epithelium and to analyze the prognostic factors. Methods 76 cases of non-vulvar intraepithelial neoplasia confirmed by pathology were selected and treated by Focused Ultrasound. Regular follow-up after the local improvement of pruritus symptoms, the use of colposcopy to observe changes in signs. Results Focused ultrasound was followed up for an average of 28.3 months (24-60 months), 39 patients were cured (27 cases of squamous epithelial hyperplasia, 12 cases of lichen sclerosus type), the total cure rate was 51% ( 39/76), with a total effective rate of 95% (72/76) and a cumulative recurrence rate of 36% (26/72). Re-focused ultrasound treatment of relapsed patients after a period of time interval can also obtain significant clinical treatment effect. Of the 18 relapsed and re-treated patients, 6 cases returned to normal, and 12 cases were relieved or alleviated. Among the 76 patients, 4 cases (2 cases of squamous epithelial hyperplasia and 2 cases of lichen sclerosus) showed a small amount of blisters on the skin in the treatment area 2 to 4 hours after treatment, and recovered after anti-inflammation and symptomatic treatment. Another two cases (one case of squamous epithelial hyperplasia and one case of lichen sclerosus) appeared superficial skin ulcer in the treatment area 2 weeks after treatment and were cured after 3 weeks of treatment such as anti-inflammatory, symptomatic and epidermal growth . 76 cases of patients after 24 to 60 months of clinical observation found no long-term complications. The effect of different anesthesia and different pathological types on the effect of focused ultrasound was not statistically different (P> 0.05). However, the shorter the course of disease and the younger the age, the better the clinical effect of focused ultrasound was. Conclusions Focused ultrasound is safe and effective for the treatment of non-xenograft intravaginal intraepithelial neoplasia without any long-term complications.