Michigan Medicine, Department of Obstetrics and Gynecology, Ann Arbor, MI.
J Low Genit Tract Dis. 2023 Apr 1;27(2):152-155. doi: 10.1097/LGT.0000000000000724. Epub 2023 Jan 23.
The aim of the study is to determine intraoperative and postoperative surgical outcomes for the treatment of vulvovaginal agglutination secondary to lichen planus (LP) following a standard protocol using intraoperative dilator placement and postoperative intravaginal steroid use.
This was a retrospective chart review of patients who underwent surgical management of vulvovaginal agglutination due to LP following a protocol that included surgical lysis of vulvovaginal adhesions, intraoperative dilator placement and removal 48 hours later, and high-potency intravaginal corticosteroid and regular dilator use thereafter. Demographic and clinical data were abstracted from the medical record and analyzed using descriptive statistics.
Thirty-four patients, with mean age 51.2 ± 11 years and body mass index 32.8 ± 8.5 kg/m 2 , underwent lysis of vulvovaginal adhesions between 1999 and 2021 with 8 different surgeons at a single institution. The mean preoperative, immediate postoperative, and 6-week postoperative vaginal lengths were 2.8 ± 1.8 cm ( n = 18), 8.0 ± 1.9 cm ( n = 21), and 7.9 ± 2.2 cm ( n = 16), respectively. The mean estimated blood loss intraoperatively was 16 ± 15 mL. No patients had a documented surgical site infection or reoperation within 30 days after surgery. Of patients who had it documented ( n = 26), 70% (18/26) reported postoperative sexual activity. Where documented, 100% (18/18) reported preoperative dyspareunia, while 17% (3/18) did postoperatively. Six percent (2/34) had recurrent severe agglutination and 3% (1/34) underwent reoperation.
Lysis of vulvovaginal adhesions, intraoperative dilator placement, and postoperative intravaginal corticosteroids with dilator use is a safe and effective treatment option to restore vaginal length for those with vulvovaginal LP.
本研究旨在通过术中放置扩张器和术后阴道内使用类固醇的标准方案，确定治疗因扁平苔藓（LP）导致的外阴阴道粘连的术中及术后手术结果。
这是一项回顾性病历研究，对按照包括外阴阴道粘连松解术、术中放置扩张器并在 48 小时后取出、随后使用高浓度阴道内皮质类固醇和常规扩张器的方案接受手术治疗因 LP 导致的外阴阴道粘连的患者进行研究。从病历中提取人口统计学和临床数据，并使用描述性统计进行分析。
1999 年至 2021 年间，在一家机构由 8 位不同的外科医生对 34 名平均年龄 51.2 ± 11 岁、体重指数 32.8 ± 8.5 kg/m 2 的患者进行了外阴阴道粘连松解术。术前、即刻术后和 6 周后阴道长度的平均值分别为 2.8 ± 1.8 cm（n = 18）、8.0 ± 1.9 cm（n = 21）和 7.9 ± 2.2 cm（n = 16）。术中估计失血量平均为 16 ± 15 mL。无患者在术后 30 天内记录到手术部位感染或再次手术。有记录的患者（n = 26）中，70%（18/26）报告术后有性生活。有记录的患者中，100%（18/18）报告术前性交困难，而术后为 17%（3/18）。6%（2/34）的患者出现严重粘连复发，3%（1/34）再次手术。
松解外阴阴道粘连、术中放置扩张器和术后阴道内使用类固醇联合扩张器是一种安全有效的治疗选择，可恢复因 LP 导致的外阴阴道粘连患者的阴道长度。
