系统给药光动力疗法与环形电切术治疗子宫颈高级别鳞状上皮内瘤变的疗效比较  

Systemic Photodynamic Therapy vs.Loop Electrosurgical Excision:Treatment of Hight Grade Squamous Intraepithelial Lesion

作　　者：乔嘉璐 邱海霞 陈琦 谭一舟 李瑞珍[4] 吴瑞芳[4] 刘昱 顾瑛 QIAO Jialu;QIU Haixia;CHEN Qi;TAN Yizhou;LI Ruizhen;WU Ruifang;LIU Yu;GU Ying(Medical School of Chinese PLA,Beijing 100853,China;Department of Laser Medicine,the First Medical Center of Chinese PLA General Hospital;Laser Medicine Center,Hainan Hospital,PLA General Hospital;Department of Obstetrics and Gynecology,Shenzhen Hospital of Peking University;Precision Laser Medical Diagnosis and Treatment Innovation Unit,Chinese Academy of Medical Sciences)

机构地区：[1]放军医学院,北京市100853 [2]中国人民解放军总医院第一医学中心激光医学科 [3]中国人民解放军总医院海南医院激光医学中心 [4]北京大学深圳医院妇产科 [5]中国医学科学院精准激光医学诊疗创新单元

出　　处：《中国激光医学杂志》2024年第5期181-188,236,共9页Chinese Journal of Laser Medicine & Surgery

基　　金：海南省院士创新平台科研专项(YSPTZX202202);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)。

摘　　要：目的比较系统给药光动力疗法(systematic-photodynamic therapy,S-PDT)和宫颈环形电切术(loop electrosurgical excision procedure,LEEP)治疗子宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)IⅡI~IⅢ,即子宫颈高级别鳞状上皮内瘤变(high grade squamous intraepithelial lesion,HSIL)的疗效及对高危型人乳头瘤病毒(high risk human papillomavirus,HR-HPV)感染的清除率。方法回回顾性分析2022年1月至2024年1月,CINIⅡI~Ⅲ级合并HPV高危型感染患者2040例,按照纳排标准从中筛选出解放军总医院海南医院接受S-PDT治疗的32例;在北京大学深圳医院接受LEEP治疗患者168例,并使用倾向性评分匹配进行配对,将配对后的患者分别纳入S-PDT组和LEEP组。其中,S-PDT组患者术前经静脉注射光敏药物血叶啉注射液48~72h后,采用激光照射子宫颈,照射光剂量为照射波长630nm,功率密度100mW/cm²光斑直径3~4cm,照射时间20~30min,能量密度120~180J/cm^(2)。LEEP组患者采用LEEP刀进行治疗。治疗后3~6个月,进行薄层液基细胞学检查(thinprepcytologic test,TCT),如TCT结果显示存在SIL风险,再行阴道镜下活检取子宫颈组织进行组织病理学检查,以评估临床疗效。同时,对宫颈分泌物进行HPV-DNA检测。并记录两组患者治疗期间不良反应和并发症发生情况。结果倾向性评分匹配后共匹配CINⅡI~Ⅲ患者62例,分别为S-PDT组患者31例,LEEP组患者31例,两组患者年龄和HR-HPV感染情况比较,差异无统计学意义(P>0.05),基线平衡。治疗后3~6个月,S-PDT组和LEEP组的HSIL完全缓解率均为77.4%,有效率分别为96.8%和89.1%,两组比较差异均无统计学意义(P>0.05)。治疗后3~6个月,S-PDT组HR-HPV清除率(87.1%)高于LEEP组(64.5%),差异具有统计学意义(P<0.05)。治疗期间两组患者均未出现严重不良反应,治疗后3~6个月S-PDT组患者未出现出血、瘢痕、子宫颈口狭窄、粘连等并发症。结论本研究结果证明,S-PDT治疗CINI~Ⅲ是一�Objective To compare the efficacy of systematic photodynamic therapy(S-PDT)and loop electrosurgical excision procedure(LEEP)in treating high grade squamous intraepithelial lesion(HSIL)and the clearance rates of high-risk human papillomavirus(HR-HPV)infection of the two methods.Methods A retrospective analysis on the clinical data of 32 CIN II-II patients given S-PDT in the Hainan Hospital of the PLA General Hospital and 168 CIN I-II patients given loop electrosurgical excision procedure(LEEP)in the Shenzhen Hospital of Peking University between Jan.2022 and Jan.2024 was conducted.Upon the screening by certain criteria and propensity score matching,the matched patients were divided into two groups:S-PDT group and LEEP group.In the S-PDT group,the patients were given S-PDT treatment,which involved the intravenous injection of the photosensitizer hematoporphyrin 48-72 hours before the procedure and the laser irradiation with a power density of 100 mW/cm^(2),a spot diameter of 3-4 cm,an irradiation time of 20-30 minutes and an energy density of 120-180 J/cm^(2).The patients in the LEEP group underwent LEEP treatment.Three to six months after the treatment,a thinprep cytologic test(TCT)was performed for the patients.Once the TCT results indicated the presence of CIN risk,colposcopy-guided biopsy of the cervical tissue was conducted for histopathological examination to assess the clinical efficacy.Additionally,HPV-DNA virological testing was performed on the cervical secretions of the patients.The adverse reactions and complications that occurred during the treatment period were also documented for both groups of patients.Results The propensity score matching resulted in a total of 62 matched CIN II-Ⅲ patients,including 31 patients in the S-PDT group and 31 patients in the LEEP group.The comparison between the two groups showed no statistically significant diference in age or HR-HPV infection status(P>0.05),indicating baseline equivalence.Three to six months after the treatment,both the S-PDT and LEEP groups exhibite

关 键 词：光动力疗法 子宫颈上皮内瘤变 人乳头瘤病毒 宫颈环形电切术 

分 类 号：R616.4[医药卫生—外科学] R713.4[医药卫生—临床医学]