HpD-光动力疗法治疗阴道高度鳞状上皮内病变的临床疗效初探  

The Clinical Efficacy and Influencing Factors of HpD-Photodynamic Therapy in the Treatment of High-grade Vaginal Squamous Intraepithelial Lesions

作　　者：张宇[1,2] 李卫平[3] 宁浩勇 边立华[3] 郭一帆[3] 郑冬梅[3] 曾晶[2] 王颖[2] 邱海霞[2] 顾瑛[2,5,6] 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)

机构地区：[1]解放军总医院研究生院,北京市100853 [2]解放军总医院第一医学中心激光医学科 [3]解放军总医院海南医院妇产科 [4]解放军总医院海南医院病理科 [5]中国医学科学院精准激光医学诊疗创新单元 [6]北京理工大学医工融合院

出　　处：《中国激光医学杂志》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)。

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.

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 

分 类 号：R616.4[医药卫生—外科学] R737.34[医药卫生—临床医学]