Meneux E, Wolkenstein P, Haddad B, Roujeau J C, Revuz J, Paniel B J
Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Créteil, France.
Obstet Gynecol. 1998 Feb;91(2):283-7. doi: 10.1016/s0029-7844(97)00596-6.
To determine the incidence, features, and surgical treatment of vulvovaginal lesions in toxic epidermal necrolysis.
Acute genital lesions were studied retrospectively in 40 women hospitalized for toxic epidermal necrolysis in a dermatologic intensive care unit. A questionnaire was sent to evaluate sequelae and their effects on sexual activity. Examination and surgical treatment were proposed to patients with symptomatic sequelae.
Twenty-eight of the 40 patients reported genital lesions during the acute phase of toxic epidermal necrolysis. No specific treatment was carried out during the acute period. Sequelae were observed in five cases, of which three involved the lower genital tract and two the vulva exclusively. The two patients with exclusive vulval involvement did not attempt any sexual activity. The other three patients with both vulval and vaginal lesions were unable to have normal sexual intercourse. Two of the three patients were treated surgically. One patient succeeded in having intercourse, but surgery failed to relieve dyspareunia.
Genital involvement is frequent during toxic epidermal necrolysis but rarely leads to symptomatic sequelae. Surgery for synechiae is sometimes necessary to recover sexual activity because the vulvovaginal canal is stenotic. Because of the partial effect on pain relief after surgery, a preventive approach should be tried.
确定中毒性表皮坏死松解症中外阴阴道病变的发生率、特征及外科治疗方法。
对在皮肤科重症监护病房住院治疗中毒性表皮坏死松解症的40例女性患者的急性生殖器病变进行回顾性研究。发放问卷以评估后遗症及其对性活动的影响。对有症状性后遗症的患者进行检查和外科治疗。
40例患者中有28例在中毒性表皮坏死松解症急性期报告有生殖器病变。急性期未进行特殊治疗。观察到5例有后遗症，其中3例累及下生殖道，2例仅累及外阴。仅累及外阴的2例患者未尝试任何性活动。另外3例同时有外阴和阴道病变的患者无法进行正常性交。3例患者中有2例接受了手术治疗。1例患者成功进行了性交，但手术未能缓解性交困难。
中毒性表皮坏死松解症期间生殖器受累很常见，但很少导致有症状的后遗症。由于外阴阴道管狭窄，有时需要进行粘连松解手术以恢复性活动。由于手术对缓解疼痛的效果有限，应尝试采取预防措施。
