1、212022 年第 9 卷第 11 期实用妇科内分泌电子杂志论 著点阵式CO2激光治疗绝经期泌尿生殖道综合征的疗效分析李海霞，王莹，徐静（临沂市妇幼保健院 妇科，山东 临沂 276016）【摘要】目的 研究点阵式CO2激光治疗绝经期泌尿生殖道综合征（GSM）的临床效果及对患者生活质量的影响。方法 选取本院收治的GSM患者68例为研究对象，根据治疗手段不同分为研究组和对照组，每组34例。研究组采用点阵式CO2激光治疗，每月1次，共3次；对照组采用阴道用普罗雌烯软膏治疗，共治疗3个月。比较两组患者治疗前及第1次治疗后1、3、6个月的阴道健康指数评分（VHIS）、阴道微生态检测结果、女性性功能指数（
2、FSFI）、满意度及不良反应发生情况。结果 对照组33例完成治疗，研究组34例全部完成治疗及随访。研究组第1次治疗后1、3、6个月的总满意度分别为70.6%、85.3%、94.1%，均高于对照组的45.5%、60.6%、54.5%，差异有统计学意义（P0.05）。治疗前，两组的FSFI、VHIS评分比较，差异无统计学意义（P0.05）；第1次治疗后1、3、6个月，两组的FSFI、VHIS评分均高于治疗前，且研究组第1次治疗后3、6个月的FSFI、VHIS评分均高于对照组，差异有统计学意义（P0.05）；两组第1次治疗后1个月的FSFI、VHIS评分比较，差异无统计学意义（P0.05）。治疗前，
3、两组患者的阴道微生态正常率比较，差异无统计学意义（P0.05）；第1次治疗后3、6个月，观察组的阴道微生态正常率均高于治疗前，第1次治疗后1、3、6个月，对照组的阴道微生态正常率均高于治疗前及同期研究组，差异有统计学意义（P0.05）。两组均未发生阴道出血、疼痛等不良反应。结论 点阵式CO2激光治疗GSM的临床效果显著，能够明显改善患者生活质量，且不良反应发生率较低，值得推广使用。【关键词】点阵CO2激光治疗；绝经期泌尿生殖道综合征；疗效Analysis of the efficacy of fractional CO2 laser in the treatment of genitourin
4、ary syndrome of menopauseLi Haixia,Wang Ying,Xu Jing(Department of Gynecology,Linyi Maternal and Child Health Hospital,Linyi 276016,China)【Abstract】Objective To study the clinical effect of fractional CO2 laser in the treatment of genitourinary syndrome of menopause(GSM)and its influence on patients
5、 quality of life.Methods A total of 68 patients with GSM admitted to our hospital were selected as the research objects and divided into a study group and a control group according to different treatment methods,with 34 cases in each group.The study group was treated with fractional CO2 laser once a
6、 month for 3 times,while the control group was treated with prostrene ointment for 3 months.The vaginal health index score(VHIS),vaginal microecological test results,female sexual function index(FSFI),satisfaction and adverse reactions were compared between the two groups before treatment and 1,3 an
7、d 6 months after the first treatment.Results 33 cases in the control group completed the treatment and 34 cases in the study group completed the treatment and follow-up.The total satisfaction of the study group at 1,3 and 6 months after the first treatment was 70.6%,85.3%and 94.1%,respectively,which
8、 were higher than 45.5%、60.6%、54.5%of the control group,and the differences were statistically significant(P0.05).Before treatment,there were no significant differences in FSFI and VHIS scores between the two groups(P0.05);at 1,3 and 6 months after the first treatment,the FSFI and VHIS scores of the
9、 two groups were higher than those before treatment,and the FSFI and VHIS scores of the study group were higher than those of the control group at 3 and 6 months after the first treatment,and the differences were statistically significant(P0.05);there were no significant differences in FSFI and VHIS
10、 scores between the two groups one month after the first treatment(P0.05).Before treatment,there was no significant difference in the normal rate of vaginal microecology between the two groups(P0.05);3,6 months after the first treatment,the vaginal microecological normal rates of the study group wer
11、e higher than before the treatment,1,3,6 months after the first treatment,the vaginal microecological normal rates of the control group were higher than before the treatment and the DOI：10.3969/j.issn.2095-8803.2022.11.006通信作者：李海霞，E-mail：222022 Vol.9 No.11Electronic Journal of Practical Gynecologica
12、l Endocrinology论 著study group in the same period,the differences were statistically significant(P0.05).No adverse reactions such as vaginal bleeding and pain occurred in the two groups.Conclusion The clinical effect of fractional CO2 laser in the treatment of GSM is significant,which can significant
13、ly improve the quality of life of patients,and the incidence of adverse reactions is low.It is worthy of popularization and use.【Key words】Fractional CO2 laser therapy;Genitourinary syndrome of menopause;The curative effect绝经后妇女的性激素水平低下，雌激素水平尤甚，可引起女性泌尿生殖道萎缩。有研究指出1，50%以上的绝经期女性会出现阴道干涩、瘙痒、灼烧感、白带增多、性交疼痛
14、等症状，称为绝经期泌尿生殖道综合征（GSM），严重影响其生活质量。目前，临床针对GSM尚无特效治疗方法，多采用口服雌激素治疗及雌激素软膏、治疗阴道炎的栓剂、阴道润滑剂等阴道局部治疗，通常为短期应用，停药后患者症状易反复。激素替代治疗（HRT）的疗效明确，但有明确的禁忌证及慎用情况，无法完全普及。而点阵式CO2激光治疗GSM在国内外文献均有报道，疗效确切，不良反应少，近年来越来越受到临床关注。本院自2020年起采用CO2点阵激光治疗GSM，取得了较好的疗效。为进一步明确点阵式CO2激光治疗GSM的临床效果及对患者生活质量的影响，特选取本院收治的GSM患者68例开展研究，现报道如下。1 资料与方法
15、1.1 临床资料选择2020年8月至2021年8月于本院确诊为GSM的患者68例为研究对象，根据治疗手段不同分为研究组和对照组，每组34例。研究组患者年龄4576岁，平均（58.27.2）岁；病程115年，平均（8.322.21）年。对照组患者年龄4675岁，平均（59.16.8）岁；病程0.514年，平均（7.832.31）年。两组患者的各项一般资料比较，差异无统计学意义（P0.05），具有可比性。纳入标准：均符合GSM的诊断标准，有外阴阴道干涩、烧灼、刺激及阴道分泌物少所致性生活障碍，同时存在尿急、尿痛、反复下尿路感染等泌尿系统症状；查体有外阴阴道黏膜萎缩；绝经时间1 年；用药前未进行相关
16、激素替代治疗。排除标准：具有雌激素应用禁忌证，如乳腺恶性肿瘤、不明原因出血等疾病者；阴道分泌物检查提示阴道炎者，如细菌、滴虫、真菌等。本研究经医学伦理委员会批准，患者均知晓研究内容，并自愿签署知情同意书。1.2 治疗方法研究组采用点阵式CO2激光治疗：协助患者取膀胱截石位，窥器打开、消毒阴道并擦干，采用点阵式CO2激光治疗仪，将一次性激光套管置入阴道至宫颈，对阴道壁进行360治疗。第1次能量10 J，密度10%；第2次能量12.5 J，密度15%，2次为1个疗程，共治疗3个疗程，每疗程间隔4周。对照组采用低剂量雌激素阴道用药治疗：给予患者普罗雌烯乳膏（北京金城泰尔制药有限公司，国药准字H20059606，规格：10 g0.1 g），睡前用药，0.5 g/次，用送药器推入阴道深处，前2周1次/d，之后2次/周，共治疗3个月。1.3 观察指标及判定标准比较两组患者的治疗前及第1次治疗后1、3、6个月的主观评价指标（女性性功能指数及患者满意度）及客观评价指标（阴道健康指数评分及阴道微生态检测结果）。阴道健康指数评分（VHIS）。量表包括阴道润滑情况、弹性、分泌物情况、上皮情况及pH值，各项评
