5-氨基酮戊酸光动力疗法联合冷冻治疗降低尖锐湿疣复发率

Incorporating 5-aminolevulinic acid-photodynamic therapy with cryotherapy in reducing the recurrence rate of condyloma acuminatum

目的比较5-氨基酮戊酸光动力疗法(ALA-PDT)、冷冻和ALA-PDT联合冷冻3种方法治疗尖锐湿疣的疗效,探索一种能有效降低尖锐湿疣复发的方法。方法尖锐湿疣165例,随机分为3组,每组55例.冷冻组,每7~10 d治疗一次,共2~6次。ALA-PDT组,皮损区涂20%ALA乳膏后3 h,以激光发射器照射,照射距离40~80 mm,照射时间为20 min,能量95~102 J/cm^2,间隔7~10 d治疗一次,共治疗3次。联合组冷冻1~5 min后行光动力治疗。治疗后随访3~12个月。结果 3组患者治疗后疣体完全清除,冷冻组复发率为58.2%,平均复发时间为(34.7±3.22)d。光动力治疗组复发率为16.4%,平均复发时间为(52.1±4.53)d,联合组复发率为7.3%,平均复发时间为(63.7±5.66)d。结论 ALA-PDT联合冷冻治疗尖锐湿疣可明显降低复发率(P<0.01),且安全、耐受性好,无明显不良反应。

Objective To evaluate the efficacy of combined therapy with both 5-aminolevuline acid- photodynamic therapy （ALA-PDT） and cryotherapy in the treatment of condyloma acuminatum（CA）. Methods One hundred and sixty-five patients with condyloma acuminatum were randomly divided into cryotherapy group, photodynamic therapy group, and cryotherapy-photodynamic therapy group （n = 55 ）. Patients were treated by cryotherapy once 7 - 10 days for 2 -6 times totally in cryotherapy group. In photodynamic therapy group, lesion area were coated with 20% ALA cream for 3 hours, laser irradiation were used by irradiation distance 40 - 80 mm, 95 - 102 J/cm2 for 20 minutes, every 7 to 10 days, 3 times totally . In cryotherapy-photodynamic therapy group, patients were treated by cryotherapy for 1 to 5 minutes and then by Photodynamic therapy. All the patients were follow-up for 3 to 12 months after treatment. Results The warts were all disappeared after treatment by three methods. The recurrence rates were 58.9%, 12.5% and 5.9% while the time of recurrence were 34.7, 52. 1 and 73. 7 days in cryotherapy group, photodynamic therapy group, and cryotherapy- photodynamic therapy group respectively. Conclusion The combination therapy of ALA-PDT with cryotherapy can significantly reduce the recurrence of CA, with good tolerance.