临床证据检索和评价截止至2002年3月.结果: ⑴硬化性苔癣: ①口服视黄醛(阿维A): 1个小样本RCT经过20～22周随访发现,阿维A与安慰剂相比,能显著减轻瘙痒和减小病变程度,但与严重的脱皮、脱发有关.②外科手术:我们未找到手术治疗妇女硬化性苔癣疗效的充足证据.③局部用0.05%丙酸氯倍他索(又名氯氟美松):1个小样本RCT经过3个月的治疗发现,局部用丙酸氯倍他索比局部用丙酸睾丸酮或矿物油软膏能更有效地控制症状.高质量的前瞻性观察性研究发现,丙酸氯倍他索用于维持治疗时副作用轻微.④局部用睾丸酮:2个小样本RCT认为,不管是用于12个月的初始治疗,还是在用了丙酸氯倍他索16周后的继续治疗,都没有证据证明丙酸睾丸酮比矿物油软膏更能缓解症状.丙酸睾丸酮与男性化有关.⑵外阴上皮内瘤样病变:我们发现,外阴上皮内瘤样病变的外科手术治疗效果和局部应用α-干扰素治疗效果,目前临床证据不足.
OBJECTIVE To introduce the method using the gracilis myocutaneous flaps to repair of vulvar defect after radical vulvectomy. METHODS The gracilis myocutaneous flaps were applied in 4 cases with vulvar carcinoma which located vestibule of vulva and bulk, and the carcinoma was large after radical resection to repair vulvar defect simultaneously. RESULTS The incision of 3 cases was healing by first intention, and 1 case with type II diabetes mellitus was healing by second intention. After followed up 3-6 years, 1 case was recurrent in 2 years after operation, 3 cases were survival without complication. CONCLUSION Vulvar reconstruction with the use of gracilis myocutaneous flaps in radical vulvectomy could markedly decrease the rate of complication.
Objective To investigate the clinical effectiveness of focused ultrasound therapy for non-neoplastic epithelial disorders of vulva. Methods Totally 90 patients with pathologically confirmed non-neoplastic epithelial disorders of vulva were enrolled in the study and randomized to receive ultrasound therapy（60 patients）or spectrum therapy (30 patients). The short-term effectiveness and recurrence rate were assessed in both groups at 6 months after treatment. Results In the ultrasound group, 29 cases were cured, 25 were significantly improved, 6 were improved and 5 experienced recurrence. Whereas, in the control group, 1 case was cured, 25 were significantly improved, 4 remained unchanged and 21 experienced recurrence. The short-term effectiveness of ultrasound therapy was superior to that of spectrum therapy (Z=-6.191, P=0.000). And ultrasound therapy was associated with a significantly lower rate of recurrence (χ2=-37.02, P=0.000). Conclusions The focused ultrasound therapy appears to be an effective approach in the treatment of non-neoplastic epithelial disorders of vulva.
ObjectiveTo evaluate the relation between protein expression of RAS-association domain family 1A (RASSF1A) gene and the occurrence and development of vulvar cancer. MethodsImmunohistochemistry was used to detect the expression of RASSF1A protein in 9 normal vulvar tissues, 12 vulvar intraepithelial neoplasm (VIN) tissues, as well as 35 vulvar cancer tissue samples which were taken from patients treated during January 2008 to December 2010. Then, we analyzed the correlation between the RASSF1A protein expression and the clinical pathological features of vulvar cancer. ResultsThe expression of RASSF1A protein in vulvar cancer samples was significantly different from that in samples of normal vulvar tissues and VIN tissues (P<0.05). Significant difference also existed in the expression of RASSF1A protein between normal vulvar tissues and VIN tissues (P<0.05). The expression of RASSF1A protein was not significantly correlated with age, grade, stage, lymph nodes involvement and sites (lateral/median) of vulvar cancer (P>0.05). ConclusionInactivation of RASSF1A gene involves in the occurrence of vulvar cancer but has no significant correlation with its development. There is no obvious correlation between cancer sites, onset ages and the expression of RASSF1A protein.
ObjectiveTo explore the indication and effectiveness of urogenital sinus surgery in feminizing genitoplasty of disorder of sex development (DSD).MethodsA retrospective analysis was made on clinical data from 22 patients with DSD who underwent one stage feminizing genitoplasty between October 2010 and December 2015. The patients’ age ranged from 1 year and 2 months to 21 years, with the median age of 2 years and 1 month. According to the Prader classification criteria, the appearance of vulvas were rated as grade Ⅰ in 7 cases, grade Ⅱ in 6 cases, grade Ⅲ in 8 cases, and grade Ⅳ in 1 case. Cystoscopy was applied before feminizing genitoplasty in all patients. Low confluence of vagina and urethra was found in 19 patients, while high confluence was found in 3 patients. The mean length of urogenital sinus was 1.6 cm (range, 0.5-3.0 cm). The mean length of water-filled vagina was 4.4 cm (range, 3.5-5.5 cm). Cervix was detected at the end of vagina in 16 patients, meanwhile absence of cervix was detected in 6 patients. The same procedures of clitoroplasty and labioplasty were used in all patients. Three procedures of urogenital sinus surgery were applied, as the " cut-back” vaginoplasty in 6 patients, the " flap” vaginoplasty in 11 patients, and the partial urogenital sinus mobilization (PUM) in 5 patients.ResultsAll procedures were completed successfully and the incisions healed by stage Ⅰ. All patients were followed up 12-74 months, with the average of 30.5 months. The outcome of appearance evaluation was excellent in 13 patients (59.1%), good in 6 patients (27.3%), and poor in 3 patients (13.6%). Urinary incontinence, post-void residual, urinary infection, and urethrovaginal fistula were not found in 17 toilet trained patients.ConclusionUrogenital sinus surgery is the most critical step in feminizing genitoplasty of DSD. It can be finished in one stage procedure with clitoroplasty and labioplasty before puberty. If thoroughly evaluation before surgery is completed and the principle of different procedures is handled, the outcome will be satisfactory.