光动力疗法联合CO_(2)激光治疗阴道上皮内瘤变的临床疗效分析  

Analysis on clinical effect of photodynamic therapy combined with CO_(2) laser in treatment of vaginal intraepithelial neoplasia

作　　者：张宛玥 张云凤[1,2] 牟婧祎 王悦 ZHANG Wanyue;ZHANG Yunfeng;MU Jingyi;WANG Yue(Department of Obstetrics and Gynecology,Henan University People’s Hospital/Henan Provincial People’s Hospital,Zhengzhou,Henan 450003,China;Henan International Joint Laboratory of Early Diagnosis and Treatment of Gynecological Malignant Tumors,Zhengzhou,Henan 450003,China)

机构地区：[1]河南大学人民医院/河南省人民医院妇产科,郑州450003 [2]河南省中美妇科恶性肿瘤早期诊治联合实验室,郑州450003

出　　处：《重庆医学》2024年第13期1988-1993,共6页Chongqing medicine

基　　金：河南省郑州市科技惠民项目(2020KJHM0020)。

摘　　要：目的 分析光动力疗法(PDT)联合CO_(2)激光治疗阴道上皮内瘤变(VaIN)的临床疗效及安全性,为VaIN患者的治疗方案提供参考。方法 选取2022年6月至2023年2月就诊于河南大学人民医院并经阴道镜下活检确诊的VaIN患者80例,采用随机数字表法分为PDT联合CO_(2)激光组和CO_(2)激光组,每组40例。随访6个月,比较两组治愈率、人乳头瘤病毒(HPV)转阴率、不良反应及复发和进展情况。结果 治疗后3、6个月,PDT联合CO_(2)激光组VaIN治愈率分别为77.50%和82.50%,CO_(2)激光组分别为75.00%和70.00%,两组间比较差异均无统计学意义(P>0.05)。两组中低级别鳞状上皮内病变(LSIL)和高级别鳞状上皮内病变(HSIL)治愈率在治疗后3、6个月亦均无明显差异(P>0.05)。治疗后3个月PDT联合CO_(2)激光组与CO_(2)激光组HPV转阴率无明显差异(71.79%vs.56.41%,P>0.05),治疗后6个月PDT联合CO_(2)激光组HPV转阴率明显高于CO_(2)激光组(82.05%vs.58.97%,P<0.05)。在CO_(2)激光组中,1例患者治疗期间出现阴道出血,2例患者出现轻度阴道壁粘连;PDT联合CO_(2)激光组患者未见明显不良反应。治疗后6个月,两组患者均无病变进展;PDT联合CO_(2)激光组1例(3.23%)复发,CO_(2)激光组3例(10.00%)复发,差异无统计学意义(P>0.05)。结论 PDT联合CO_(2)激光治疗VaIN具有较高的治愈率和HPV清除率,是治疗VaIN的一种安全有效的方法。Objective To analyze the clinical efficacy and safety of photodynamic therapy(PDT) combined with CO_(2) laser in treating vaginal intraepithelial neoplasia(VaIN) to provide reference for the treatment scheme of the patients with VaIN.Methods A total of 80 patients with definitely diagnosed VaIN by colposcopic biopsy in Henan University People's Hospital from June 2022 to February 2023 were selected and divided into the PDT combined CO_(2) laser group and CO_(2) laser group by the random number table method,40 cases in each group.The follow up lasted for 6 months.The cure rate,negative conversion rate of human papillomavirus(HPV),adverse reactions,recurrence and progression were compared between the two groups.Results After 3,6 months of treatment,the cure rates of VaIN in the PDT combined CO_(2) laser group were 77.50% and 82.50%,respectively,which in the CO_(2) laser group were 75.00% and 70.00% respectively,and the differences between the two groups were not statistically significant(P>0.05).There was no statistically significant difference in the cure rates of low-grade squamous intraepithelial lesion(LSIL) and high-grade squamous intraepithelial lesion(HSIL) after 3,6 months of treatment between the two groups(P>0.05).There was no statistically significant difference in the negative conversion rate of HPV after 3 months of treatment between the PDT combined with CO_(2) laser group and CO_(2) laser group(71.79% vs.56.41%,P>0.05).However,after 6 months of treatment,the negative conversion rate of HPV in the PDT combined CO_(2) laser group was significantly higher than that in the CO_(2) laser group(82.05% vs.58.97%,P<0.05).In the CO_(2) laser group,one case experienced vaginal bleeding during treatment process,two cases appeared mild vaginal wall adhesion.No obvious adverse reaction was observed in the PDT combined with CO_(2) laser group.After 6 months of treatment,there was no case with progression of lesion in both groups;there were one case(3.23%) of relapse in the PDT combined CO_(2) laser group and three

关 键 词：阴道上皮内瘤变 光化学疗法 CO_(2)激光 联合治疗 人乳头瘤病毒 

分 类 号：R737.34[医药卫生—肿瘤]