光动力治疗葡萄酒色斑长期疗效的病理特征分析

Histopathological characteristics of long-term efficacy of photodynamic therapy for port-wine stain

目的探讨光动力治疗(photodynamic therapy,PDT)葡萄酒色斑(port-wine stain,PWS)的组织学特征,明确PWS达到临床治愈的组织病理学深度。方法回顾性分析自2012年1月至2019年10月于上海交通大学医学院附属第九人民医院整复外科血管瘤与脉管畸形诊疗中心就诊的面部PWS并接受过PDT治疗11例患者的临床资料,所有面部PWS患者在平均(4.91±5.41)次PDT治疗后病灶呈现红斑消退的痊愈病灶及对治疗抵抗的残留病灶。患者均进行组织活检。在痊愈部位、残留部位和正常皮肤样本中比较血管数量、直径和深度。结果11例患者PDT术后平均随访6年,痊愈部位800μm深度范围内的扩张血管均已闭塞并呈裂隙状。残留病灶与痊愈病灶的血管数量、血管深度无差异(P>0.05),而血管直径(39.76±15.30)μm显著大于痊愈部位(27.82±12.38)μm(P=0.001)。结论PDT破坏PWS血管深度可达800μm。血管直径的差异可能是影响PDT治疗PWS疗效的重要原因之一。

Objective To explore the histological characteristics of pulsed dye laser(PDL)in the treatment of port-wine stain(PWS)and to clarify the histopathological depth of PWS to achieve clinical cure.Methods From January 2012 to October 2019,the clinical data of 11 patients with facial PWS underwent photodynamic therapy(PDT)were retrospectively analyzed.The mean value of PDT were(4.91±5.41)times in all patients with facial PWS.The lesions were cured with erythema regressed.Some lesions were residual because of treatment resistance.Biopsy was performed in all patients.The number of blood vessels,vascular diameter and depth were compared in recovery sites,residual sites and normal skin.Results All patients were followed-up for 6 years after PDT.The recovery site showed that within 800μm depth of dermal-epidermal junction,the dilated vessels were occluded after PDT.There was no statistical significance in number of blood vessels and vascular depth between residual and regressive lesions(P>0.05),while the vascular diameter of residual lesions(39.76±15.30)μm was significantly larger than that of regressive lesions(27.82±12.38)μm(P=0.001).Conclusion In patients with facial PWS,the vascular within 800μm depth of dermal-epidermal junction can be closed by PDT.The difference in vascular diameter may be one of the important reasons affecting the efficacy of PDT for PWS.