摘要
目的初步评价HpD-光动力疗法(photodynamic therapy,PDT)治疗阴道高度鳞状上皮内病变(high grade squamous intraepithelial lesion,HSIL)的有效性和安全性。方法选择2019年1月至2020年9月,经组织病理学诊断为阴道HSIL患者15例,所有患者均合并高危型人乳头瘤病毒(highrisk human papillomavirus,HR-HPV)感染,经静脉注射2.0~2.5 mg/kg血卟啉注射液(hematoporphyrin derivative,HpD)后48~72h,采用波长630 nm激光进行照射,行PDT治疗,每个光斑照射的光剂量为:功率密度100 mW/cm^(2)、照射时间30 min、能量密度180 J/cm^(2)。术后3~6个月随访,月行组织病理学检查和HR-HPV检测判定疗效;以数字疼痛评分法(numerical pain rating scale,NPRS)系统记录患者术中及术后的疼痛情况;同时记录术中、术后7d、1个月、3~6个月的不良反应发生情况。结果15例患者行一次PDT治疗后3~6个月,HSIL患者中8例痊愈、3例有效、4例无效,有效率为73.3%;合并的HR-HPV感染清除率为26.7%(4/15)。6例(占40.0%)患者在术中,4例(占26.7%)患者在术后1周内出现可耐受的下腹疼痛,NPRS评分分别为(0.73±1.2)分和(0.47±0.8)分。术后1例患者出现光敏反应;无一例患者在术中、术后发生出血、感染、瘢痕和阴道狭窄等并发症。结论HpD-PDT治疗阴道HSIL疗效确切、安全微创,值得临床推广应用。
Objective To investigate the efficacy and safety of HpD-photodynamic therapy in the treatment of high-grade vaginal squamous intraepithelial lesions.Methods Fifteen patients diagnosed by pathology as vaginal HSIL were selected from Jan.2019 to Sep.2020.PDT was performed by 630 nm laser 48 h-72 h after intravenous injection of 2.0-2.5 mg/kg hematoporphyrin derivative(HPD).The power density is 100 mW/cm^(2),the irradiation time is 30 min,and the energy density is 180 J/cm^(2).The curative effect was evaluated by histopathological biopsy and HPV examination 3-6 months after operation.The numerical pain rating scale(NPRS)system was used to record the intraoperative and postoperative pain.Patient’s satisfaction was self-evaluated during the operation,the adverse reactions and complications were observed at 1 week,1 month and 3-6 months after operation.Results 15 patients were treated using PDT.After 3-6 months,8 cases were reported complete remission(CR),3 cases were reported partial remission(PR)and 4 cases were reported no remission.The effective rate was 73.3%.All 15 patients were high-risk HPV infected and the clearance rate was 26.7%(4/15).6 patients(40%)had tolerable lower abdominal pain within 1 week after operation,4 patients(26.7%)had tolerable lower abdominal pain within 1 week after operation(NPRS was 0.73±1.2 and 0.47±0.8)and 1 patient had local photosensitive reaction.Conclusions PDT is effective,safe and non-invasive in the treatment of high squamous intraepithelial lesions of the vagina.It is worthy of clinical promotion and application.
作者
张宇
李卫平
宁浩勇
边立华
郭一帆
郑冬梅
曾晶
王颖
邱海霞
顾瑛
ZHANG Yu;LI Wei-ping;NING Hao-yong;BIAN Li-hua;GUO Yi-fan;ZHENG Dong-mei;ZENG Jing;WANG Ying;QIU Hai-xia;GU Ying(Chinese PLA Medical School,Beijing 100853,China;Department of Laser Medicine,the First Medical Center,Chinese PLA General Hospital;Department of Obstetrics and Gynecology,Hainan Hospital of Chinese PLA General Hospital;Department of Pathology,Hainan Hospital of Chinese PLA General Hospital;Precision Laser Medical Diagnosis and Treatment Innovation Unit,Chinese Academy of Medical Sciences;Institute of Engineering Medicine,Beijing Institute of Technology)
出处
《中国激光医学杂志》
CAS
2021年第4期181-186,238,239,共8页
Chinese Journal of Laser Medicine & Surgery
基金
国家重点研发计划项目(2018YFB0407200)
中国医学科学院医学与健康科技创新工程项目资助(2019-I2M-5-061)
海南省重点科技计划项目(ZDKJ2019012)
解放军总医院临床科研扶持基金(2018FC-WJFWZX-2-16)。
关键词
光动力疗法
血卟啉注射液
高度鳞状上皮内病变
激光
高危型HPV
Photodynamic therapy
High-grade squamous intraepithelial lesion
Vagina
Laser
High-risk human papillomavirus
