5-氨基酮戊酸光动力疗法联合手术治疗巨大尖锐湿疣的疗效观察

Effect of 5-aminolevulinic acid photodynamic therapy and surgery in treatment of giant condyloma acuminatum

目的观察5-氨基酮戊酸光动力疗法（ALA-PDT）联合手术治疗巨大尖锐湿疣的临床疗效。方法对22例外生殖器、肛周、肛管、会阴部、腹股沟巨大尖锐湿疣患者进行ALA-PDT联合手术治疗,其中男性15例,女性7例。通过手术切削的方法将疣体突出皮面的部分去除,之后病变部位及其周围至少1 cm的范围内使用ALA-PDT治疗,7-10 d治疗1次,共治疗3-5次,对每次治疗后的不良反应、疗效等作出评价,并进行6-12个月的随访,对其预后及复发情况作出评判。结果 22例巨大型尖锐湿疣患者经手术联合ALA-PDT治疗3-5次后,20例患者疣体完全消失,治愈率91%;术后局部均会出现红肿、疼痛、渗出、少量渗血,病变靠近尿道部位治疗后1-4 d内排尿时可出现轻微的烧灼感,无需特殊处理,可自行消退;其中4例患者出现局部明显红肿、糜烂、少量脓性渗出。但是所有患者均未发生严重感染、溃疡、瘢痕和尿道、肛管狭窄等不良反应;随访6-12个月,原位复发2例,复发率为9%。结论 ALA-PDT疗法联合手术是治疗巨大型尖锐湿疣的新疗法,它具有安全、有效、痛苦小、不良反应小、术中出血少、术后无需特殊护理、对局部结构及功能影响小等特点,同时与传统治疗方法相比,可明显提高治愈率,降低复发率。

Objective To investigate the clinical effect of 5-aminolevulinic acid photodynamic therapy（ALAPDT） and surgery in the treatment of giant condyloma acuminatum. Methods Twenty-two patients with giant condyloma acuminatum at the genitals, anus, anal canal, perineum, and groin underwent ALA-PDT and surgery, including15 males and 7 females. The protruding giant condyloma acuminatum of the skin was surgically removed. Then, the lesions and the surroundings（at least 1 cm range） were treated by ALA-PDT, once for every 7-10 d, for a total of 3-5times. The adverse reactions and effects after each treatment were evaluated, with 6-12 months of follow-up. The prognosis and recurrence were evaluated. Results After the 22 patients with giant condyloma acuminatum were treated by ALA-PDT and surgery for 3-5 times, 20 patients were completely cured, with the cure rate of 91%. Local swelling,pain, seepage, and a small amount of bleeding occurred after the surgery. Slightly burning pain occurred near the ure-thra lesions at 1 to 4 days after the treatment, which could be spontaneously regressed and no special treatment was required. Four patients appeared local obvious swelling, erosion, and a small amount of purulent exudates. However,serious infection, ulcers, scars, urethral and canal stricture, and other adverse reactions were not occurred in all pa-tients. All patients were followed up for 6-12 months. There were 2 cases of recurrence in situ, and the recurrence rate was 9%. Conclusion ALA-PDT and surgery if a new treatment for giant condyloma acuminatum, which is effective and safe, with less pain, fewer side effects, less intraoperative bleeding, no need of special postoperative care, and less influence on local structure and function. Compared with conventional treatment, it can significantly improve the cure rate and reduce the recurrence rate.