摘要
目的 探讨聚焦超声治疗外阴白色病变的可行性和有效性。方法 采用超声监测和组织病理学检查相结合的方法 ,观察 76例经病理检查证实为外阴白色病变的患者 ,聚焦超声治疗期间及治疗后 ,症状、体征及局部组织结构的变化。采用链霉卵白素 过氧化物酶 (SP)免疫组化技术 ,检测治疗前后患者外阴白色病变组织 (石蜡切片 )中 ,血管内皮细胞分化抗原决定簇 (clusterofdifferentiationofendothelialcell,CD34)及髓磷脂碱性蛋白 (myelinbasicprotein ,MBP)的阳性表达率。结果 聚焦超声治疗后 ,患者的局部瘙痒症状明显缓解 ,甚至完全消失 ,外阴的形态和色泽基本恢复正常 ,治疗有效率达 94 7%。治疗后局部皮肤的表皮完整 ,真皮组织有一过性的充血、水肿 ,水肿的高峰期在治疗后的2 4～ 4 8h ,以后逐渐消退 ,至治疗后 7～ 10d恢复正常。治疗后 1个月复查 ,外阴白色病变部位的皮肤逐渐恢复正常形态 ,并有色素沉着 ,局部表皮保持完整。聚焦超声治疗前后的病理检查结果显示 ,治疗后表皮及真皮层组织结构均逐渐恢复正常 ,基底层细胞色素沉积 ,真皮内的微血管明显增多 ,且管腔形态正常 ,浸润的淋巴细胞数量明显减少。外阴皮肤内CD34、MBP等的阳性表达率比治疗前明显升高 (P <0 0 5 )。结论 聚焦超声用于治疗外阴白色?
Objective To explore the feasibility and efficacy of focused ultrasound for the treatment of vulvar dystrophy, including squamous hyperplasia (SH) and lichen sclerosus (LS). Methods A total of 76 eligible patients with vulvar dystrophy (45 SH and 31 LS) were treated with focused ultrasound between 1999 and 2002. Before and after ultrasound therapy, both ultrasonography and biopsies of the lesions were performed to monitor and evaluate the changes of the lesion being treated. The positive expressions of CD34 (cluster of differentiation of endothelial cells), a marker of the epithelial cells of blood vessels and myelin basic protein (MBP), a marker of the oligodendrocytes and Schwann cells were tested using the streptavidin-peroxidase (SP) immunohistochemistry method before and after the ultrasound procedure to evaluate the effects of ultrasound treatment. Results In two years, follow-up, 49 of 76 cases (32 SH and 17 LS) were cured, 23 (11 SH and 12 LS) improved, and 4 (2 SH and 2 LS) persisted. The response rate was 94.7% (72/76). The positive expression of CD34 and MBP significantly increased at the treated region (P<0.05). Grey-scale ultrasound imaging showed a localized hypoechoic region after the treatment, which recovered to normal appearance within 7-10 days. Conclusion Vulvar dystrophy can be treated with focused ultrasound effectively and safely. This approach appears to be a new promising treatment method, although further studies are still needed.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2004年第6期373-377,i001,共6页
Chinese Journal of Obstetrics and Gynecology
