The Comparison Of Fractional CO₂ Laser And Focused Ultrasound In The Treatment Of Vulvar Lichen Sclerosus

Vulvar lichen sclerosus?VLS?is a subtype of vulvar hypopigmented diseases.pruritus of the vulva is the main symptom of this disease,and the clinical symptoms are stubborn and cannot be completely cured,which seriously affects the patients'physical and mental health.fractional CO₂ laser and focused ultrasound are common physical therapies for the treatment of vulvar lichen sclerosus,but the comparison between the two treatment methods,there is no research at home and abroad.the purpose of this study is to explore the differences of efficacy and complications between the two treatment methods,in order to provide references for clinical research and individualized treatments of vulvar lichen sclerosus.ObjectiveTo explore the efficacy of fractional CO₂ laser and focused ultrasound in the treatment of vulvar lichen sclerosus,and to summarize their clinical application indications,to provide a basis for the development of individualized treatment plans.Materials and methods1 Study objectA total of 107 severe the vulvar lichen sclerosus were analyzed from the third affiliated Hospital of Zhengzhou University From September 2016 to August 2018.107 cases of patients,according to the principle of voluntary knowledge,randomly divided into study group?52 cases?and control group?55 cases?.The study group was treated with fractional CO₂ laser?3 times as a course of treatment,with an interval of 1 month?,while the control group was treated with focused ultrasound?2times as a course of treatment.Every three months?.Follow-up was conducted 1month after the first treatment,1 month and 3 months after the end of the total course of treatment.2 cases was withdrawn from the study group and 10 cases were lost to follow-up.In the control group,3 patients dropped out and 8 patients lost follow-up.Finally,the research group completed all the treatment procedures and successfully followed up 40 patients,while the control group completed all the treatment procedures and successfully followed up 44 patients.There were no significant differences between the two groups in terms of severity and comorbidities?P>0.05?.2 Study analysisThe experimental group was treated with fractional CO₂ laser from Italy DEKA and topical anesthesia with 2%lidocaine cream before operation.The treatment parameters were:Point power 20²4 J/s,point spacing 250⁴00?m and the depth is about 600¹000?m.The control group was treated with the non-invasive treatment system of German sea pole star gynecological focused ultrasound,the local anesthetic ultrasound probe was used to irradiate the lesion,the frequency was 8¹2 MHZ,the power was 3.5⁴.5 W,and the radiation method was continuous linear scanning at a speed of 5¹0mrds.3 Observed indicators and postoperative follow-up timeObservation:Visual analogue scale?VAS?was used to evaluate the severity of vulvar pruritus,intercourse pain,chapped skin and changes of vulva color before and after treatment.The quality of life of patients was evaluated by dermatology life quality index?DLQI?before and after treatment.The female sexual distress scale-revised?FSDS-R?was used to evaluate sexual satisfaction before and after treatment.To evaluate the recurrence rate and adverse reactions?infection,rupture,scar?after treatment.Postoperative follow-up:the main use of outpatient follow-up,auxiliary telephone follow-up form.The follow-up period was one month after the first treatment and one month and three months after the end of the total course of treatment.4 Statistical analysisAll the date was processed by SPSS23.0 statistical software.The measurement data were expressed?`x±s?standard and the t test was used for the intra-group comparison and the independent t test was used for the comparison between the two groups.The count data were expressed as rate?%?and?² test was performed.P-valve<0.05 was considered have statistical significance.Result1.Pruritus of the vulva skinThe pruritus scores of the study group and control group before treatment were7.02±1.62 points and 6.86±1.54 points.There was no significant difference in the degree of pruritus between the two groups?P>0.05?;1 month after the first treatment,1 month and 3 months after the end of the total treatment,The pruritus scores were?3.31±1.09 points and 3.17±1.06 points?,?2.24±1.10 points and 2.05±1.08 points?,and?1.48±1.17 points and 1.17±1.01 points?were lower than before treatment.The difference was statistically significant?P<0.05?.There was no significant difference between the two groups after treatment?P>0.05?.2.Vulvar cleft palate3.The vulvar cleft palate scores of the study group and control group before treatment were 3.45±1.50 points and 3.40±1.54 points.There was no significant difference between the two groups?P>0.05?;1 month after the first treatment,1month and 3 months after the end of the total treatment,The vulvar cleft palate scores were?1.65±1.18 points and 2.40±1.05 points?,?0.90±0.85 points and 1.65±0.93points?,and?0.65±0.62 points and 1.35±0.75 points?were lower than before treatment.The difference was statistically significant?P<0.05?.After treatment,the study group were lower than those in the control group,and the difference was statistically significant?P<0.05?.4.Sexual painThe sexual pain scores of the study group and control group before treatment were 2.25±1.07 points and 2.30±1.08 points.There was no significant difference between the two groups?P>0.05?;1 month after the first treatment,1 month and 3months after the end of the total treatment,the sexual pain scores were?0.95±0.83points and 1.85±0.93 points?,?0.70±0.65 points and 1.65±0.67 points?,and?0.60±0.58 points and 1.35±0.75 points?were lower than before treatment.Statistical significance?P<0.05?.After treatment,the study group were lower than those in the control group and the difference was statistically significant?P<0.05?.5.Vulvar skin colorThe skin color scores of the study group and control group before treatment were3.71±1.53 points and 4.26±1.54 points.There was no significant difference between the two groups?P>0.05?;1 month after the first treatment,1 month and 3 months after the end of the total treatment,The skin color scores of the vulva were?2.39±1.04and 1.72±0.99?,?1.92±0.99 and 1.22±0.97?,and?1.31±0.98 and 0.88±0.86?were lower than before treatment,and the difference was statistically significant?P<0.05?.After treatment,the skin color scores of the control group were lower than those of the study group,and the difference was statistically significant?P<0.05?.6.Female sexual functionThe sexual distress scores of the study group and control group before treatment were 16.47±6.11 points and 16.12±5.89 points.There was no significant difference between the two groups?P>0.05?;1 month after the first treatment,1 month and 3months after the end of the total treatment,the distress scores were?9.29±3.62 points and 11.24±4.29 points?,?6.57±2.88 points and 8.44±3.37 points?,and?5.08±3.05points and 6.86±3.26 points?were lower than before treatment.Statistical significance?P<0.05?.After treatment,the scores of each stage of the study group were lower than the control group,and the difference was statistically significant?P<0.05?.7.Quality of lifeThe quality of life scores of the study group and control group before treatment were 11.90±5.29 points and 11.06±4.00 points.There was no significant difference between the two groups?P>0.05?;1 month after the first treatment,1 month and 3months after the end of the total treatment,the quality of life scores were?5.71±2.72points and 5.36±2.41 points?,?3.59±2.59 points and 3.44±2.33 points?,and?2.08±2.05 points and 1.92±1.79 points?were lower than before treatment.Statistically significant?P<0.05?.There was no significant difference between the two groups after treatment?P>0.05?.8.Adverse reactions and recurrenceThe adverse reactions of the two groups of patients were followed up within 3months after the end of treatment.The study group:infection occurred:0 case,ulceration:2 cases,scar formation after treatment:0 case,recurrence:2 cases;control group:infection occurred:2 cases,ulceration:6 cases,scar formation after treatment:1 case,recurrence:5 cases.There was no significant difference in adverse reactions and recurrence between the two groups?P>0.05?.Conclusion1.Both fractional CO₂ laser and focused ultrasound were effective methods for the treatment of vulvar lichen sclerosus.2.Focused ultrasound is superior to fractional CO₂ laser in improving the color of vulva skin in the short time.3.fractional CO₂ laser is superior to focused ultrasound in improving genital cleft palate,sexual pain and improving sexual function in the short time.