单纯光动力疗法及联合手术治疗皮肤恶性肿瘤的临床观察

Clinical Observation of Photodynamic Therapy alone and It in Combination with Surgery for Skin Cancer

目的 观察单纯光动力疗法及联合手术治疗皮肤恶性肿瘤的疗效。方法 138例确诊皮肤恶性肿瘤患者，根据患者病变部位、大小、皮损侵入程度、年龄、身体状况及手术意愿，68例患者选择单纯光动力治疗，70例患者光动力联合手术治疗。结果 70例手术联合光动力治疗者，69例皮损基本消退，治愈率98．6％，其中46例先做手术，24例先做光动力治疗再行手术治疗，术后ALA—PDT治疗I一4次，平均2，2次；68例单纯行AI。A—PDT治疗患者，63例皮损基本消退，治愈率92．6％，治疗次数2～7次，平均3．2次，另有5例患者未愈，但皮损较前改善；基底细胞癌（BCC）治疗2～7次，平均3．2次，鳞状细胞癌（SCC）治疗3～6次，平均3．8次，鲍温病治疗2～5次，平均3．15次，乳房外Paget治疗2～6次，平均3．6次。术后不良反应为一过性红肿或色素沉着。对BCC和SCC的手术患者、非手术患者分别行样本均数“检验（d=0．05），结果示，无论BCC还是SCC，手术患者AIJA—PDT治疗次数均少于非手术患者（P〈0．05）；手术患者中SCC和BCC治疗次数差异无统计学意义（P〉0．05），但在非手术患者中BCC治疗次数少于SCC（P〈0．05）。结论 单纯光动力疗法及联合手术治疗均是安全、有效的方法，联合手术治疗可以缩短治疗周期，且BCC患者治疗次数少于SCC患者。

Objective To observe the clinical efficacy of photodynamic therapy （ALA-PDT） alone and in combination with surgery, on skin cancers. Methods One hundred and thirty-eight patients with early skin cancer were enrolled in this study. Aceolxling to the location of lesion,degree of skin invasion,age and patients＇ physical condition,68 patients were treated with ALA-PDT and 70 patients were treated with ALA-PDT plus surgery. Results 69 of 70 patients （ 98.6% ）, including 46 patients given surgery first and 24 patients receiving ALA- PDT first,were cured by surgery plus ALA-PDT. The average ALA-PDT treatment times were 2.2 （ 1 ~ 4 times） ; 63 out of 68 patients （92.6%） treated with ALA-PDT alone were cured with an average of 3.2 treat- ments （2 -7 times）. The lesions were improved in the 5 uncured patients. SCC patients were treated 3.8 times （3 ~6 times）. The average treatment limes for BCC were 3.2 times （2 -7times） ,3.15 times （2 ~5 tithes） fi）r Bowen＇s disease,3.6 times （3 ~ 6 times） for extramammary Paget＇s disease. Adverse reactions included temporary swelling or pigmentation. Either BCC or SCC patients treated with surgery required fewer ALA-PDT treatments than those without surgery （P 〈 0.05 ）. There are no differences in ALA-PDT treatment times between BCC and SCC patients with surgery. But in patients with no surgical treatment, BCC patients needed fewer ALA-PDT treatments than SCC patients （P 〈 0.05）. Conclusion ALA-PDT in combination with surgery is safe and effective for skin cancers. Applications of ALA-PDT after surgery can shorten treatment course. BCC patients require fewer ALA-PDT treatments than SCC patients.