外阴白色病变的中西医结合治疗研究.pdf

上海交通大学 硕士学位论文 外阴白色病变的中西医结合治疗研究 姓名：东敏 申请学位级别：硕士 专业：妇产科学 指导教师：刘建华 20090401 上海交通大学医学硕士学位论文 I 外阴白色病变的中西医结合治疗研究 摘 外阴白色病变的中西医结合治疗研究 摘 要要 目的目的: 探讨应用中药方剂五白合剂（白芨、白癣皮、白芷、白茅藤、白僵 蚕、苦参等）、聚焦超声及聚焦超声联合五白合剂治疗女性外阴白色病 变的疗效，尤其是治疗瘙痒的疗效，以及相关因素对疗效的影响 方法方法: 经病理检查证实为外阴白色病变的患者50例随机分为三组：五白合 剂外用治疗组17例，聚焦超声治疗组17例，聚焦超声联合五白合剂治疗 组16例治疗前对外阴病变进行评价，治疗后定期随访临床症状、体征、 组织学变化,进行疗效评价；记录治疗及随访期间副反应及并发症；按临 床瘙痒评分表及瘙痒VAS表记录瘙痒评分， 评价三种治疗方法对瘙痒的治 疗效果；总体评价相关因素对疗效评价影响数据的统学计处理应用χ 2 检验 结果: 结果: 五白组、超声组和联合治疗组的有效率分别为 64.71%, 82.35% 和 93.75%，各组间均有显著性差异(P＜0.05)，以聚焦超声联合五白合剂有 效率最高；超声组有效率显著低于联合治疗组，而显著高于五白合剂组。

上海交通大学医学硕士学位论文 II 三种治疗方法均能有效改善瘙痒(P＜0.05)， 其中聚焦超声联合五白合剂 治疗外阴瘙痒疗效最好(P＜0.05)未发现重大并发症，且轻微副反应的 发生不影响疗效研究中的不同相关因素对疗效的影响有显著性差异 (P<0.05)，病程越短、年龄越小，治疗的效果越好；病理类型中鳞状上 皮增生型疗效较好(P＜0.05) 结论: 结论: 中药五白合剂外用对外阴白色病变有一定的疗效，聚焦超声治疗是 一种有效率较高的方法，聚焦超声联合五白合剂外用治疗外阴白色病变 可进一步提高治疗的有效率三种方法均能显著改善瘙痒症状治疗后 1 年瘙痒改善率、总有效率以聚焦超声联合五白合剂外用治疗显著高于 其它两组，有必要在临床上进一步研究探讨 关键词：关键词：外阴白色病变，聚焦超声，中医，疗效 上海交通大学医学硕士学位论文 III TREATMENT OF VULVAR DYSTROPHIES WITH COMBINATION OF CHINESE TRADITIONAL MEDICINE AND HIGH-INTENSITY FOCUSED ULTRASOUND Abstract Object: To evaluate the effects of Wu-Bai Decoction (traditional Chinese medicine), high-intensity focused ultrasound (HIFU), the combination of Wu-Bai Decoction and HIFU in the treatment of vulvar dystrophy, especially the improvement for pruritus. Moreover, to explore the related factors that influences the prognosis of vulvar dystrophy. Method: Fifty patients with vulvar dystrophy, histopathologically diagnosed, were randomly divided into 3 groups: Wu-Bai Decoction group (17 cases), HIFU group (16 cases), and combination group (17 cases). They were treated respectively with Wu-Bai Decoction , HIFU, or the combination of Wu-Bai Decoction and HIFU. Before and after the treatment, the lesions of vulvar dystrophy were evaluated in clinical symptoms, signs and histopathological 上海交通大学医学硕士学位论文 IV manifestation. The pruritus degree and the pruritus improvement after treatment of the 3 groups were measured by means of a clinical pruritus scale questionnaire and VAS score table for pruritus. And the related factors that influence the therapeutic effects were also explored. Result: There is a significant difference (P<0.05) in pruritus improvement and curative effects after treatment among the three groups. The effective rates in Wu-Bai Decoction group, HIFU group and combination group were respectively 64.71%, 82.35% and 93.75%. The effective rate in the combination group is significantly higher than the other 2 groups. The effective rate in HIFU is significantly lower than that in the combination group, and significantly higher than that in Wu-Bai Decoction group. The improvement of pruritus after treatment in 3 groups were significant (P<0.05) , and in combination group the improvement was the most significant (P<0.05). No major complications occurred, and the adverse reaction were slight , which didn’t decrease the curative effects. The influence of different related factors on curative effects was significantly different (P<0.05). Either the shorter the course of the disease is or the younger the patient is，the better the therapeutic effects. The squamous hyperplasia type of vulvar dystrophy responded the best to the treatment 上海交通大学医学硕士学位论文 V (P<0.05). Conclusion: In the treatment for vulva dystrophy, Chinese traditional medicine Wu-Bai Decoction could be effective, HIFU treatment was even more effective. The treatment of HIFU combined with Wu-Bai Decoction turned out to be the most effective. The results of 1 year’s follow-up showed that there is an excellent improvement and a high curative rate in the combination therapy of HIFU and Wu-Bai Decoction. Therefore it is necessary for the combination therapy of HIFU and Wu-Bai Decoction to be further clinically studied. Keywords: vulvar dystrophy, high intensity focused ultrasound(HIFU), Chinese traditional medicine, therapeutic effect 上海交通大学医学硕士学位论文 IX 注释说明注释说明 SH Squamous Hyperplasia 鳞状上皮增生型 LS Lichen Sclerosus 硬化性苔藓型 SHl9:3-5. [2] 张启瑞， 李贵容， 刘键， 等． 外阴硬化萎缩性苔癣治疗后的光镜与电镜观察． 中 华妇产科杂志 1990;25(1):24-25. [3] Cappelletto T, Propersi G, Molin M, et a1. Chronic vulvar dystrophies. Surgical therapy. Clin Exp Obstet Gynecol 1981;8(4):182-186. [4] Abramov Y, Elchalal U, Abramov D, et a1. Surgical treatment of vulvar lichen sclerosus: a review. Obstet Gynecol Surv 1996; 51(3):193-l99. [5] Virgili A, Lauriola MM, Mantovani L, et al. Vulvar lichen sclerosus: 11 women treated with tacrolimus 0.1% ointment. Acta Derm Venereol 2007 ;87(1):69-72. [6] Matsumoto Y, Yamamoto T, Isobe T, et al. Successful treatment of vulvar lichen sclerosus in a child with low-concentration topical tacrolimus ointment. J Dermatol 2007;34(2):114-6. [7] Oskay T, Sezer HK, C neyt Gen, et al. Pimecrolimus 1% cream in the treatment of vulvar lichen sclerosus in postmenopausal women.Int. J Dermatol 2007;46(5):527-32. [8] Cattaneo A, Bracco GL, Mae。