手术联合氨基酮戊酸光动力治疗乳房外Paget病对复发的影响

Effect of surgery combined with aminolevulinic acid-based photodynamic therapy on the recurrence of extramammary Paget＇s disease

目的 探讨外科手术治疗联合氨基酮戊酸（ALA）光动力疗法（PDT）对乳房外Paget病预后的影响。方法 通过前瞻性、开放性、对照研究，上海市皮肤病医院病理确诊的38例乳房外Paget病患者分为两组：单纯手术治疗组21例，手术联合ALA？PDT治疗组17例。手术联合ALA？PDT治疗组术后2周1次ALA？PDT治疗，共3次。38例患者3个月随访1次，随访 ≥ 12个月。对两组的复发情况进行比较。结果 随访时间（35.45 ± 16.98）个月（12 ~ 58个月），单纯手术治疗组7例复发，中位复发时间9个月（6 ~ 18个月）；手术联合ALA？PDT治疗组1例复发，复发时间为治疗结束后18个月。手术联合ALA？PDT治疗组较单纯手术组复发率降低，两组比较差异有统计学意义（P 〈 0.05）。联合治疗组复发时间较单纯手术组有所延长。手术后行光动力治疗患者对疼痛等耐受性好。结论 手术联合ALA？PDT治疗能降低乳房外Paget病的术后复发，改善患者的预后。

Objective To evaluate the effect of surgery combined with aminolevulinic acid （ALA）-based photodynamic therapy （PDT） on the prognosis of extramammary Paget′s disease. Methods A prospective open-labelled controlled trial was conducted. A total of 38 patients with pathologically comfirmed extramammary Paget′s disease were enrolled from Shanghai Dermatology Hospital, and divided into 2 groups to be treated with surgery alone （surgery alone group, n = 21） or surgery combined with ALA-PDT （combination group, n = 17）. Patients in the combination group received ALA-PDT after the surgery once every two weeks for 3 sessions. All the patients were followed up once every three months for more than 12 months, and the incidence of relapse was evaluated and compared between the 2 groups after the treatment. Results During the follow-up of 12 - 58 months （mean, 35.45 ± 16.98 months）, 7 patients in the surgery alone group experienced relapse, and the median time to relapse was 9 months, with an upper quartile of 18 months and a lower quartile of 6 months. However, relapse only occurred in 1 patient in the combination group, and the time to relapse was 18 months after the end of treatment. The recurrence rate was significantly lower in the combination group than in the surgery alone group （P 〈 0.05）, and the time to relapse was also longer in the combination group than in the surgery alone group. Furthermore, ALA-PDT after the surgery was well tolerated in all the patients. Conclusion Surgery combined with ALA-PDT can reduce the recurrence rate of extramammary Paget′s disease, and improve its prognosis.