5-氨基酮戊酸光动力疗法联合CO_2激光和(或)手术治疗难治性尖锐湿疣45例疗效观察

Efficacy of 5-aminolevulinic acid photodynamic therapy(ALA-PDT) combined with CO_2laser and/or surgery in treatment of 45 patients with refractory condyloma acuminatum: a clinical observation

目的探讨5-氨基酮戊酸光动力疗法（ALA-PDT）联合CO2激光和（或）手术治疗难治性尖锐湿疣的临床疗效。方法对45例尿道、肛周、肛管、外生殖器难治性尖锐湿疣患者进行ALA-PDT联合局部CO2激光和（或）手术治疗,其中男性25例,女性20例,单纯尿道病变8例,单纯外生殖器病变者18例,尿道合并外生殖器病变者6例,单纯肛周病变8例,肛周合并肛管病变者3例,外生殖器合并肛周病变2例,其中2例为巨大尖锐湿疣,1例发生于外生殖器、1例发生于肛周。7~10 d治疗1次,根据病情不同共治疗3~5次,对每次治疗后的不良反应、疗效等做出评价,并对其进行至少3个月的随访,对其预后及复发情况作出评判。结果 45例难治性尖锐湿疣患者经ALA-PDT治疗后,3~5次治疗后42例患者疣体完全消失,治愈率达93.3%;1例病变发生于龟头及冠状沟部位的患者和1例尿道、阴道、外阴大面积皮疹的患者于治疗后出现治疗部位小水疱,数小时后局部水疱破溃出现浅表糜烂,均未发生严重感染、溃疡、瘢痕和尿道狭窄等不良反应,不良反应发生率为4.44%;随访6~12个月,原位复发3例,复发率为7.14%。结论 ALA-PDT是治疗尿道、外生殖器、肛周、肛管尖锐湿疣的新疗法,具有有效、安全、简便、痛苦小、术后无需特殊护理等特点,尤其适用于尿道、阴道、肛管内等隐蔽部位的病变,联合CO2激光和（或）手术治疗,可明显提高治愈率。

Objective To investigate the clinical efficacy of the 5-aminolevulinic acid photodynamic therapy（ALA-PDT） combined with CO2 laser and/or surgery in treatment of refractory condyloma acuminatum. Methods Fortyfive patients with refractory condyloma acuminatum in urethra, crissum, anal canal, and genitalia received ALA-PDT combined with CO2 laser and/or surgery, including 25 males and 20 females [8 simple urethral lesions, 18 simple geni-tal lesions, 6 urethral and genital lesions, 8 simple crissum lesions, 3 crissum and anal canal lesions, 2 genitalia and crissum lesions, and 2 giant condyloma acuminatum（1 in genitalia and 1 in crissum）]. All patients were treated once in 7-10 days, with a total of 3-5 times of treatments according to different conditions. The adverse reactions and effects were evaluated after each treatment. All patients were followed up for at least 3 months to determine the prognosis and recurrence. Results After ALA-PDT treatments in 45 patients with refractory condyloma acuminatum, the warts in 42 patients disappeared completely after 3-5 times of treatments, with the cure rate of 93.3%. After the treatment, the blisters occurred in the balanus and coronary sulcus of one patient and the other with large areas of rash in urethra,vagina, and vulva. Crissum, anal canal, and genitalia. The local blisters ruptured with superficial erosion after several hours. No adverse reactions of severe infection, ulcer, scar, and urethrostenosis were found, and the rate of adverse reactions was 4.44%. After 6-12 months of follow-up, there were 3 recurrences in situ, with the recurrence rate of7.14%. Conclusion ALA-PDT is a new method to treat condyloma acuminatum in urethra, genitalia, crissum, and anal canal, which is effective, safe, and simple, with less pain and no postoperative special care. It specifically favors the treatment for lesions in concealed positions of urethra, vagina, and anal canal, and can significantly increase the cure rate combined with CO2 laser and/or surgery.