光动力联合CO_2激光治疗尿道口、肛门尖锐湿疣的疗效观察

The efficacy of rphotodynamic therapy combined CO_2 laser in treating patients with urethra and anus condyloma acuinatum

目的：观察5-氨基酮戊酸光动力（ALA-P DT）疗法联合CO2激光治疗尿道口、肛门尖锐湿疣（CA）的临床疗效及安全性。方法：将69例患者随机分为三组各23例,A组采用单纯ALA-PDT治疗,B组采用单纯CO2激光治疗,C组采用ALA-PDT联合CO2激光治疗,观察痊愈率、术后复发及不良反应。结果：A组在治疗1~4次后,13例复发,10例痊愈;B组1次治疗后100%清除,术后8例复发,15例痊愈;C组经3例复发,痊愈20例。三组患者痊愈率组间比较具有显著差异,B与C组比较差异显著,A与C组比较差异不显著。三组患者术后1个月时AC复发率组间比较无显著差异。术后2、3个月及1年时,C组复发率低于其他两组,且与其他两组比较具有显著差异。三组均有疼痛、水肿或破溃不良反应,但组间比较无显著差异,A组与C组均无瘢痕形成及色素改变,B组6例浅表瘢痕,3例色素沉着,明显高于A组与C组。结论：ALA-PDT联合CO2激光治疗尿道口、肛门CA,效果显著,复发率低,不良反应轻微,较单一治疗更加安全有效。

Objectives： To observe the clinical efficacy and safety of patients with urethra,anus condyloma acuinatum（ CA） treated with 5- aminolevulinic acid photodynamic（ ALA- P DT） therapy combined with CO2 laser. Methods： 69 patients were randomly divided into 3 groups of 23 cases,group A for pure ALA- PDT treatment,group B using pure CO2 laser treatment,ALA- PDT combined CO2 laser for group C. The cure rate,recurrence and adverse reactions were observed. Results： After group A having received treatment for 1- 4 times,13 cases of recurrence,10 cases cured; after the first treatment 100% clear in group B,8 cases of recurrence and 15 cases were cured; in group C,3 cases of recurrence,20 cases were cured. Difference in the cure rates among the 3groups were significant,significant difference between group B and C,and no significant difference between group A and C. Difference in the recurrence rates among the 3 groups were not significant after 1 month of treatment. The recurrence rate of group C 2 month,3 month and 1 year after was significant lower than the other groups,with significant difference. All the three groups showed pain,swelling or ulceration of adverse reactions,but without significant difference. Group A and group C had no scarring and pigment changes; in group B,6 cases had superficial scar and3 cases of pigmentation,which was significantly higher than that in group A and group C. Conclusion： ALA- PDT combined CO2 laser is of significant effect,low recurrence rate,and mild adverse reactions in treating patients with urethra and anus CA,thusly safer and more effective.