5-氨基酮戊酸光动力疗法联合二氧化碳激光治疗尖锐湿疣的疗效观察

5-aminolevulinic acid-mediated photodynamic therapy combined with CO_2 laser therapy in treatment of condyloma acuminatum

目的比较5-氨基酮戊酸光动力疗法(5-aminolevulinic acid-mediated photodynamic therapy,ALA-PDT)和二氧化碳(CO_2)激光治疗尖锐湿疣(CA)的临床疗效。方法将同济大学附属第十人民医院皮肤科2010年4月至2010年12月就治的111例尖锐湿疣患者分为3组,第一组为特殊部位(尿道口、系带或宫颈部位)的疣体患者,共17例,单用ALA-PDT治疗;余94例患者随机分为两组,每组47例,分别采用ALA-PDT联合CO_2激光治疗和单一CO_2激光治疗。ALA-PDT每周治疗1次,3次为1个疗程。CO_2激光治疗根据疣体大小一次或分次清除疣体。3组患者治疗结束后每1、2、3个月分别电话随访一次。结果单用ALA-PDT组一个疗程结束后的清除率为93.4%(16/17),3个月后总复发率为11.8%(2/17)。联合治疗组和CO_3激光单一治疗组3个月后的总复发率分别为14.9%(7/47)和55.3%(26/47),差异有统计学意义(x^2=16.857,P<0.001)。结论ALA-PDT联合CO_2激光治疗CA疗效确切,复发率低;ALA-PDT可有效治疗特殊部位的疣体,临床适用范围广。

Objective To evaluate the efficacy of 5-aminolevulinic acid-mediated photodynamic therapy （ALA-PDT） combined with CO_2 laser therapy in treatment of condyloma acuminatum.Methods One hundred and eleven patients with condyloma acuminatum admitted from April to December 2010 were enrolled in the study.Seventeen cases whose condylomas are at urethral orifice,vinculum or cervix uteri were treated with ALA-PDT alone.Other 94 cases were randomly assigned into two groups with 47 in each,who were treated by ALA-PDT combined with CO_2 laser therapy or C_2 laser alone,respectively. Results The clearance rate was 93.4%（16/17） and the relapse rate was 11.8%（2/17） in patients treated with ALA-PDT alone.The relapse rates of ALA-PDT combined with C_2 laser and C_2 laser alone were 14.9%（7/47） and 55.3%（26/47）,respectively（x^2=16.857,P0.001）.Conclusion ALA-PDT is effective in treatment of condyloma acuminatum in special locations with low relapse rate. ALA-PDT combined with C_2 laser therapy has a better effect and lower relapse rate in treating condyloma acuminatum than C_2 laser therapy alone.