光动力疗法治疗下生殖道病变的疗效及其对妊娠的影响

Effects of photodynamic therapy on lower reproductive tract lesions and pregnancy

目的观察光动力疗法治疗下生殖道低级别鳞状上皮病变(LSIL)的疗效及其对妊娠结局的影响。方法120例经病理诊断为宫颈、外阴、阴道LSIL的患者随机均分为光动力组、激光组和对照组。光动力组采用光动力疗法治疗(功率90 mW,每个部位照射20~25 min,共3次);激光组采用二氧化碳激光治疗(功率25 W,照射5 min);对照组不做处理。治疗后12个月随访液基薄层细胞检测(TCT)和HPV,比较三组治愈率、HPV清除率、不良反应发生率及妊娠结局。结果与对照组比较,光动力组和激光组治愈率(85.0%和87.5%vs.12.5%)和HPV清除率(70.0%和75.0%vs.25.0%)均较高(P<0.05),光动力组和激光组治愈率和HPV清除率比较无统计学差异(P>0.05)。光动力组瘢痕发生率低于激光组(2.5%vs.22.5%)(P<0.05)。光动力组和对照组剖宫产率低于激光组(16.7%和19.0%vs.50.0%)(P<0.05)。结论光动力疗法与二氧化碳激光治疗下生殖道LSIL的疗效相仿,但不良反应少,对妊娠结局影响小。

Objective To observe the effects of photodynamic therapy on low grade squamous intraepithelial lesions in the lower reproductive tract and pregnancy outcome.Methods Eighty patients with pathologically diagnosed low-grade squamous intraepithelial lesions in the cervix,vulva and vagina were equally randomized into 3 groups.The patients in group A accepted photodynamic therapy(power:90 mW,irradiation time:20-25 minutes per site,3 times in total)and those in group B accepted carbon dioxide laser therapy(power:25 W,irradiation time:5 minutes).Another 40 patients did not accept any treatment as the controls(group C).The patients were followed up with thinprep cytologic test and human papillomavirus(HPV)for 12 months.The cure rate,HPV clearance rate,incidence of adverse responses and pregnancy outcome were compared among the three groups.ResultsCompared to group C,groups of A and B had higher cure rate(85.0%and 87.5%vs.12.5%)and HPV clearance rate(70.0%and 75.0%vs.25.0%)(P<0.05),which were not significantly different between group A and group B(P>0.05).The incidence of scar in group A was lower than that in group B(2.5%vs.22.5%)(P<0.05).Cesarean section rate in groups of A and C was lower than that in group B(16.7%and 19.0%vs.50.0%)(P<0.05).Conclusion The therapeutic effect of photodynamic therapy on low grade squamous intraepithelial lesions in the lower reproductive tract is similar to carbon dioxide laser therapy,but photodynamic therapy has less adverse response and effect on pregnancy outcome.