Wejde Ellen, Ekmark Ann Nozohoor, Stenström Pernilla
Faculty of Medicine, Lund University, Lund, Sweden.
Department of Paediatric Surgery, Skåne University Hospital, Institution of Clinical Sciences, Lund University, S-221 85, Lund, Sweden.
BMC Pediatr. 2018 Mar 8;18(1):104. doi: 10.1186/s12887-018-1018-x.
Topical oestrogen and manual separation are the main treatments for labial adhesions. The aim was to evaluate treatment of labial adhesions and compare the outcome of topical oestrogen treatment with that of manual separation.
All girls aged 0-12 years admitted to a tertiary centre for paediatric surgery for labial adhesions were included. The study design was dual: The first part was a retrospective chart review of the treatment success according to the medical charts. The second part was a cross-sectional parent-reported long-term outcome study (> 6 months after last treatment finished).
In total 71 patients were included and the median follow-up time for the chart study was 84 (6-162) months after treatment with oestrogen or manual separation. Oestrogen was the first treatment for 66 patients who had an initial successful rate of 62% but this was followed by recurrences in 44%. Five patients had manual treatment as their first treatment and they had a 100% initial success rate followed by recurrences in 20%. Therefore, for the first treatment course there was a final success rate of 35% for oestrogen and 80% for manual separation (p = 0.006). Corresponding final success rates including all consecutive treatments over the study period were 46/130 (35%) for oestrogen and 21/30 (70%) for manual separation (p = 0.001). The success rate for oestrogen did not differ if treatment was given in a course length of 0-4 weeks (39% success) or > 4 weeks (32% success) (p = 0.369). In the parent-reported long-term outcome study the response rate was 51% (36/71). Parents reported that recurrences of adhesions after last prescribed/performed treatment were frequent: in total 25% of patients still had adhesions corresponding to 8/29 (29%) of those whose last treatment was oestrogen and 1/9 (11%) of those whose last treatment was manual separation.
Due to the results recurrences are common after both oestrogen and manual separations. However, the overall final outcome after manual separation seems to be more successful when compared to that of topical oestrogen treatment.
局部使用雌激素和手法分离是阴唇粘连的主要治疗方法。目的是评估阴唇粘连的治疗情况，并比较局部使用雌激素治疗与手法分离治疗的效果。
纳入所有因阴唇粘连入住三级儿科手术中心的0至12岁女孩。研究设计分为两部分：第一部分是根据病历对治疗成功率进行回顾性图表审查。第二部分是一项横断面的家长报告的长期结局研究（最后一次治疗结束后>6个月）。
共纳入71例患者，图表研究中雌激素或手法分离治疗后的中位随访时间为84（6 - 162）个月。66例患者首次接受雌激素治疗，初始成功率为62%，但随后复发率为44%。5例患者首次接受手法治疗，初始成功率为100%，随后复发率为20%。因此，对于第一个疗程，雌激素的最终成功率为35%，手法分离为80%（p = 0.006）。包括研究期间所有连续治疗的相应最终成功率，雌激素为46/130（35%），手法分离为21/30（70%）（p = 0.001）。如果治疗疗程为0 - 4周（成功率39%）或>4周（成功率32%），雌激素的成功率无差异（p = 0.369）。在家长报告的长期结局研究中，应答率为51%（36/71）。家长报告称，在最后一次规定/进行的治疗后粘连复发很常见：总共25%的患者仍有粘连，其中最后一次治疗为雌激素的患者中有8/29（29%），最后一次治疗为手法分离的患者中有1/9（11%）。
由于这些结果，雌激素和手法分离后复发都很常见。然而,与局部使用雌激素治疗相比，手法分离后的总体最终效果似乎更成功。
