钬激光联合光动力治疗尿道内尖锐湿疣临床疗效观察

Clinical Observation on Combine Holmium Laser Through Ureteroscope with ALA-PDT in Treating Urethral Condyloma Acuminatum

目的探讨钬激光联合氨基酮戊酸光动力疗法(ALA-PDT)治疗尿道内尖锐湿疣的疗效及安全性。方法尿道内尖锐湿疣患者60例,随机分为3组。钬激光组20例采用输尿管镜下钬激光汽化疣体。光动力疗法组20例采用光动力疗法每周治疗1次,共治疗3次。钬激光联合光动力疗法组20例,先采用输尿管镜用钬激光汽化疣体,1周后行光动力治疗,每周治疗1次,共治疗3次。比较3组的治愈率、复发率及不良反应。结果术后随访6个月,钬激光组治愈率100%,复发率40%;光动力组治愈率60%,复发率16.67%;联合组治愈率100%,复发率10%。联合组治愈率高于光动力组,而复发率又低于钬激光组,两者差异有统计学意义(P<0.05)。光动力疗法不良反应表现为局部皮肤灼热感,无尿道狭窄发生。结论钬激光联合光动力治疗尿道内尖锐湿疣能提高治愈率,有效减少复发率,大大缩短病程。

Objective In order to evaluate the efficacy and safety of holmium laser combined with 5-aminolevulinic acidbased photodynamic therapy（ALA-PDT） in treating patients with urethral condyloma acuminatum（CA）. Methods Sixty patients with urethral CA were randomly divided into three groups. Twenty cases in holmium laser group were treated with uretoscopic holmium laser evaporating, 20 cases in ALA-PDT group were treated with ALA-PDT once per week for three weeks,and 20 cases in the combination group were first treated by vaporizing the verruca with holmium laser through ureteroscope, then after one week followed by three sessions of ALA-PDT with once a week for three times. The cure,recurrence rate and adverse reaction were evaluated. Results After six-month follow up,the cure rate of holmium laser group was 100%, recurrence rate was 40%. The cure rate of ALA-PDT group was 60%, recurrence rate was 16.67%. The cure rate of the combination group was 100%, recurrence rate was 10%. The combination group showed higher cure rate compared with ALA-PDT group（P〈0.05） and lower recurrence rate compared with holmium laser group（P〈0.05）. Local burning sensation was the main adverse reaction of ALA-PDT therapy. No urethrostenosis case encountered. Conclusion Holmium laser combined with ALA-PDT in treating urethral CA is a safe and effective therapy with higher cure rate, lower recurrence rate and shorter course of disease than the conventional therapies.