ALA联合小剂量HPD激光光动力学治疗皮肤肿瘤临床研究  

The Clinical Study of Topical ALA Combined with Systemic Small Dose of HPD in the Treatment of Skin Cancers

作　　者：朱菁[1] 张慧国[1] 陆丽萍[1] 严敏[1] 

机构地区：[1]上海交通大学医学院附属仁济医院,上海200001

出　　处：《应用激光》2009年第6期548-555,共8页Applied Laser

基　　金：上海市科委光计划资助课题(项目编号:022261017)

摘　　要：目的:局部外敷ALA和静脉注射小剂量HPD联合用药后进行激光光敏诊断和光动力学治疗,探讨这种联合用药光动力学疗法治疗皮肤恶性肿瘤的疗效。并与常规HPD-PDT及激光气化肿瘤合并ALA-PDT治疗作临床疗效对比。方法:30例患者,45处皮肤损害。采用ALA-PDT与小剂量HPD-PDT联合的方案进行治疗。光敏药物剂量:8%ALA霜剂外敷,1.5mg/kg HPD静脉用药,波长630nm半导体激光照射(功率密度250mW/cm^2,照射时间20分钟/光斑)。同时在PDT治疗过程中,及以后的随访中均以激光光敏诊断技术指导治疗及判断避光时间。并与常规HPD(5mg/kg)-PDT治疗皮肤恶性肿瘤43例及三周前激光气化肿瘤加20%ALA霜剂外敷光动力学治疗29例作疗效比较。结果:ALA联合小剂量HPD激光光动力学治疗组,除一例鳞癌Ⅱ级患者及一例恶性黑色素瘤患者出现复发外,其余患者对联合治疗的效果均佳,随访6～24月,均获得了痊愈,近期痊愈率93.33%,显效率6.67%,皮肤避光时间减少到10～14天。HPD-PDT治疗皮肤恶性肿瘤组43例,40例达近期痊愈,近期痊愈率91.43%,3例显效,显效率8.57%(显效3例,2例为色素型基底细胞癌,1例为直肠癌肛周复发)。激光气化肿瘤加ALA-PDT治疗组29例,26例一次治疗痊愈,近期痊愈率89.66%,3例显效,显效率10.34%(显效3例,2例鳞癌Ⅱ级经二次治疗痊愈,1例汗管癌7周复发改用手术治疗)。结论:1.ALA联合小剂量HPD的光动力学疗法对于诊断和治疗皮肤恶性肿瘤有较佳的疗效。两种光敏剂的联合使用,使皮肤避光时间由原来常规剂量HPD-PDT所必需的4～5周缩短到2周左右,并改善了ALA-PDT作用深度浅(2mm)的弊端。2.光敏诊断是一种简便、快捷、灵敏、非创伤性的肿瘤诊断方法,对于提高肿瘤的早期诊断率有很大意义,又能作为判断避光时间的辅助手段。3.光动力学治疗是一种对肿瘤组织杀伤具有高度选择性的微创技术,病人对整个治疗过程的Objective： To explore the efficiency of PDD and PDT with application of topical ALA in combination with low dosage systemic HPD intravenous injection （MPDT） in several kinds of skin cancers. The efficacy of routine HPD-PDT and laser vaporization in combination with topical ALA - PDT in the treatment of skin cancer is also compared. Methods： 45skin cancers lesions from 30 patients（16 patients of skin squamous cell carcinoma, 9 patients of skin basal cell carcinoma,3 patients of skin extramammary Paget＇s disease. 1 patient of skin malignant tumor, 1 patient of sweat gland carcinoma） were included. 30 patients were treated by the combination treatment of laser irradiation, ALA in combination with HPD as the sensitizers of the photodynamic therapy. Topical 8% ALA cream plus intravenous injection of 1.5mg/kg of HPD were applied prior to the diode laser irradiation of 630nm, 250mW/cm^2 for 20minute/photospot. The other 43 skin cancer patients were treated by routine 5mg/kg HPD-PDT and the remaining 29 skin cancer patients were treated by laser vaporization in combination with topical 20% ALA-PDT. Photodynamic diagnosis was used during both the PDT process and the following-up. Results： Except one patient with recurrent SCC （grade Ⅱ） and one patient with skin malignant tumor, all patients achieved complete remission by such combination PDT treatment in the 6-24 month follow-up period, CR93. 33%, SR6. 67%. The 43 skin cancer patients were treated by routine 5mg/kg HPD-PDT. In 40 cases, CR is as high as 93.02%. In the other 3 cases, SR is as high as 6. 98% （1 patient is recurrent recurrent perianal carcinoma and 2 patients are recurrent basel cell carcinoma）. 29patients of skin cancer were treated by laser vaporization in combination with topical 20% ALA-PDT. 26 of these have achieved CR as high as 89. 66%. 3 of these have achieved SR as high as 10.34% （2 patients are squamous cell carcinoma treated by ALA-PDT 2 twice times, 1 patient is sweat gland carcinoma）. The patients treated with HPD m

关 键 词：ALA—PDT联合小剂量HPD-PDT 激光光敏诊断及光动力学治疗 皮肤恶性肿瘤 

分 类 号：S858.292[农业科学—临床兽医学] Q2[农业科学—兽医学]