Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, 80131, Italy.
Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, 80131, Italy.
Lasers Surg Med. 2021 Apr;53(4):521-527. doi: 10.1002/lsm.23311. Epub 2020 Aug 14.
Fractional CO laser has been proposed as an effective treatment for the genitourinary syndrome of menopause (GSM). However, the effects of laser treatment on vulvar tissue have never been assessed. We aimed to assess histological changes related to fractional CO laser in vulvar tissue from GSM patients.
STUDY DESIGN/MATERIALS AND METHODS: A single-center observational prospective cohort study was performed enrolling all GSM patients from July 2017 to October 2018. Patients underwent three outpatient vulvovaginal applications of fractional CO laser and vulvar biopsy before and after treatment. Rates of histological changes in vulvar tissue, the difference in means of Vulva Health Index (VuHI), Vaginal Health Index (VHI), Visual Analogue Scale scores for GSM symptoms, and procedure-related pain, and rate of patient's overall satisfaction with treatment were assessed. Univariate comparisons between continuous variables were performed by using the paired t-test (α error = 0.05).
Of 20 enrolled patients, 18 underwent all laser applications, and 15 underwent both vulvar biopsies. 93.3% of patients showed remodeling of vulvar connective tissue; 80% showed improvement in vulvar epithelium trophism and 86.7% showed neovascularization. Differences in means between before and after treatment were significant for VuHI, VHI, and all GSM symptoms. Means ± standard deviation of the degree of pain at each laser application were 4.4 ± 0.9, 3.7 ± 1.6, and 2.9 ± 1.9. The rate of overall satisfaction with the treatment was 72.2%.
Fractional CO laser leads to a restoration of the normal architecture of vulvar tissue, with significant improvement in GSM-related signs and symptoms, and overall satisfaction with the treatment in most GSM patients. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
分 子 CO2 激光已被提议作为治疗女性泌尿生殖系统绝经期综合征（GSM）的有效方法。然而，激光治疗对外阴组织的影响从未被评估过。我们旨在评估 GSM 患者外阴组织中与分 子 CO2 激光相关的组织学变化。
研究设计/材料和方法： 2017 年 7 月至 2018 年 10 月，我们进行了一项单中心观察性前瞻性队列研究，纳入了所有 GSM 患者。患者在治疗前后接受了三次门诊外阴阴道分 子 CO2 激光治疗和外阴活检。评估外阴组织的组织学变化率、外阴健康指数（VuHI）、阴道健康指数（VHI）、GSM 症状视觉模拟评分的平均值差异、与治疗相关的疼痛以及患者对治疗的总体满意度。使用配对 t 检验（α 误差=0.05）对连续变量进行单变量比较。
在 20 名入组患者中，18 名患者接受了所有激光治疗，15 名患者接受了外阴活检。93.3%的患者显示外阴结缔组织重塑；80%的患者显示外阴上皮营养改善，86.7%的患者显示新生血管形成。治疗前后 VuHI、VHI 和所有 GSM 症状的平均值差异均有统计学意义。每次激光应用时疼痛程度的平均值±标准差分别为 4.4±0.9、3.7±1.6 和 2.9±1.9。治疗总体满意度为 72.2%。
分 子 CO2 激光可恢复外阴组织的正常结构，显著改善 GSM 相关体征和症状，且大多数 GSM 患者对治疗总体满意。激光外科医学。© 2020 威利父子公司。
