子宫切除术后及 HPV 感染的高级别阴道上皮内病变行光动力疗法的疗效。
Effects of photodynamic therapy in the treatment of high-grade vaginal intraepithelial lesions following hysterectomy and HPV infection.
机构信息
Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
出版信息
Photodiagnosis Photodyn Ther. 2023 Jun;42:103336. doi: 10.1016/j.pdpdt.2023.103336. Epub 2023 Feb 10.
BACKGROUND
Non-invasive treatment therapy, such as 5-Aminolevulinic acid photodynamic therapy (ALA-PDT), has gained attention for its effect on select cervical and vaginal lesions. To investigate the effect of ALA-PDT on high-grade vaginal intraepithelial lesions (HG VAIN) after hysterectomy and high-risk human papillomavirus (HR-HPV) infection, in this study, we evaluated the clinical efficacy and safety of ALA-PDT in 23 patients with HG VAIN following hysterectomy and HPV.
METHODS
23 patients with HG VAIN after hysterectomy were selected for photodynamic therapy, and the therapeutic effect, adverse reactions, recurrence rate and HPV clearance rate were analyzed respectively. The patients were followed up at 3, 6, 9, and 12 months after ALA-PDT. HPV, thinprep cytologic test (TCT) and reid colposcopic index (RCI) score should be performed 3 months after treatment. When the RCI score is higher than or equal to 3, a colposcopy biopsy should be conducted, the additional ALA-PDT should be continued if residual lesions were detected. When the RCI score is lower than or equal to 2, HPV and TCT should be reviewed every 3 months.
RESULTS
After 3 months of photodynamic therapy, 21 patients were cured, with the cure rate of 91.3% (21/23). Two patients (8.7%) had residual lesions, which had degraded compared with the previous. After treatment, the overall HR-HPV clearance rate was 56.5% at 3 months, 65.2% at 6 months, 69.5% at 9 months, and 74% at 12 months. No obvious adverse reactions were found during and after treatment. Moreover, no recurrence occurred during the whole follow-up period.
CONCLUSIONS
Compared with other therapies, ALA-PDT is a novel therapy with non-invasive procedure in HG VAIN after hysterectomy. ALA-PDT can be used for the treatment of HG VAIN after hysterectomy, moreover, it can not only effectively clear HR-HPV, but also can prevent the recurrence and progression of vaginal lesions caused by persistent HR-HPV infection.
背景
5-氨基酮戊酸光动力疗法（ALA-PDT）等非侵入性治疗方法因其对特定宫颈和阴道病变的疗效而受到关注。为了研究 ALA-PDT 对子宫切除术后高级别阴道上皮内病变（HGVAIN）和高危型人乳头瘤病毒（HR-HPV）感染的影响，本研究评估了 ALA-PDT 治疗 23 例子宫切除术后合并 HR-HPV 感染的 HGVAIN 的临床疗效和安全性。
方法
选择 23 例子宫切除术后合并 HGVAIN 的患者进行光动力治疗，分别分析其治疗效果、不良反应、复发率和 HPV 清除率。患者在 ALA-PDT 后 3、6、9 和 12 个月进行随访。治疗后 3 个月行 HPV、液基薄层细胞学检查（TCT）和 Reid 阴道镜检查指数（RCI）评分。当 RCI 评分≥3 时，行阴道镜活检，如果发现残留病变，继续行额外的 ALA-PDT。当 RCI 评分≤2 时，每 3 个月复查 HPV 和 TCT。
结果
光动力治疗 3 个月后，21 例患者治愈，治愈率为 91.3%（21/23）。2 例患者（8.7%）有残留病变，与前次相比有所降级。治疗后 3 个月总 HR-HPV 清除率为 56.5%，6 个月为 65.2%，9 个月为 69.5%，12 个月为 74%。治疗中和治疗后无明显不良反应。而且，整个随访期间无复发。
结论
与其他治疗方法相比，ALA-PDT 是一种治疗子宫切除术后 HGVAIN 的新型非侵入性治疗方法。ALA-PDT 可用于治疗子宫切除术后的 HGVAIN，不仅能有效清除 HR-HPV，还能预防持续性 HR-HPV 感染引起的阴道病变复发和进展。
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