皮肤磨削术联合氨基酮戊酸光动力疗法治疗鼻部结节型基底细胞癌25例

Dermabrasion combined with aminolevulinic acid-based photodynamic therapy for the treatment of nasal nodular basal cell carcinoma： 25 case reports

目的 探讨皮肤磨削术联合氨基酮戊酸光动力疗法（ALA-PDT）治疗鼻部结节型基底细胞癌（BCC）的疗效.方法 25例经病理确诊、皮损面积＞1 cm2、无骨或软骨侵犯的鼻部结节型BCC患者,实施皮肤磨削术联合ALA-PDT治疗.首先去除肿瘤病灶（对于突出皮肤表面的病灶先实施切削术,然后实施磨削术）,术后创面即刻避光条件下外敷20％氨基酮戊酸3～4 h,然后平均100 J/cm2 LED光照射20 min.ALA-PDT每周1次,连续3周.术后观察创面愈合情况和时间;1年后随访观察肿瘤复发、瘢痕形成、外观效果等情况,并做出综合评价.结果 25例患者未见创面感染,平均创面愈合时间为（11.2± 1.3）d.术后1年未见复发病例;1例患者发生瘢痕挛缩,3例患者有轻度的瘢痕增生,4例患者遗留凹陷性瘢痕.除1例患者对术后外观基本满意外,24例患者均对术后外观满意.结论 皮肤磨削术联合ALA-PDT治疗鼻部结节型BCC操作简便,创面愈合快,术后复发率低,患者满意度高,值得临床推广.

Objective To investigate the efficacy of dermabrasion combined with aminolevulinic acid-based photodynamic therapy （ALA-PDT） for the treatment of nasal nodular basal cell carcinoma （nBCC）.Methods Twentyfive patients who were pathologically diagnosed as nasal nBCC with lesion area 〉 1 cm2 but no bone or cartilage involvement,were included in this study and treated with dermabrasion combined with ALA-PDT.At first,the part of tumor protruding outside the skin was removed by artherectomy,then dermabrasion was carried out.The wound surface was topically treated with 20% aminolevulinic acid solution for 3-4 hours away from light immediately after surgery,then irradiated with LED light at a mean dose of 100 J/cm2 for 20 minutes.ALA-PDT was performed once a week for 3 consecutive weeks.The degree of and time required for wound healing were assessed,and tumor recurrence,cicatrization and appearance outcomes were observed during 1 year after surgery.Efficacy was assessed comprehensively.Results No postoperative wound infection occurred in these patients,and the average time for wound healing was （11.2 ± 1.3） days.During 1 year after the treatment,no recurrence was found,while cicatricial contracture developed in 1 case,mild proliferative scar in 3 cases,and depressed scar in 4 cases.All the patients were satisfied with the treatment outcomes,except 1 patient who was basically satisfied.Conclusions Dermabrasion combined with ALA-PDT is easy to operate with rapid wound healing,low postoperative recurrence rate and high degree of patient satisfaction,and is worthy of clinical promotion.