局部应用5-氨基酮戊酸光动力疗法与手术治疗术后复发性宫颈高级别鳞状上皮内病变的对比研究
Comparative study of topical 5-aminolevulinic acid photodynamic therapy and surgery for recurrent cervical high-grade squamous intraepithelial lesions following surgery.
作者信息
Wang Bingjie, Yuan Shuyu, Su Yuehui, Zhang Chunyan, Zhou Mengjiao, Zhang Mengzhuo, Dai Kaili, Wang Yimeng, Cao Lili, Zhang Ting, Zhang Mengzhen
机构信息
Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Photodiagnosis Photodyn Ther. 2024 Apr;46:103974. doi: 10.1016/j.pdpdt.2024.103974. Epub 2024 Feb 17.
OBJECTIVE
The study aimed to compare the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and surgery in treating recurrent cervical high-grade squamous intraepithelial lesions (HSIL) after surgery due to precancerous lesions.
METHODS
A total of 41 patients with recurrent cervical HSIL after surgery for precancerous lesions were studied retrospectively. Patients underwent ALA-PDT or surgery and were followed up at 3, 6, 9 and 12 months and then every six months after that. Clinical data were collected and the efficacy and safety of the two treatment methods were compared.
RESULTS
Of the 41 patients with recurrent cervical HSIL after conization, 15 cases received ALA-PDT and 26 received surgery. At the six-month follow-up, the lesions' complete remission (CR) rate was 93.33 % in ALA-PDT group and 88.46 % in the surgery group. The human papillomavirus (HPV) clearance rates were 66.67 % and 73.08 %, respectively. No significant differences concerning the lesions' CR rate and the HPV clearance rate were observed between the two groups (P>0.05). At the twelve-month follow-up, the HPV clearance rates were 80.00 % and 91.67 %. No significant differences concerning the HPV clearance rate were observed between the two groups (P>0.05). In the surgery group, the HPV clearance rate and the lesions' CR rate were lower in patients over 45 years of age (25.00% vs. 81.82 %, P = 0.031; 50.00% vs. 95.45 %, P = 0.052). During the follow-up, there was no significant difference in the recurrence rate between the two groups (P>0.05). In addition, none of the patients progressed. In women treated with ALA-PDT, there was no vaginal bleeding, and no harmful effects on the cervical organizational structure or functions compared to the surgery group, and two women delivered successfully after ALA-PDT treatment.
CONCLUSIONS
The efficacy of ALA-PDT was similar to that of surgery in treating recurrent cervical HSIL following surgery, with fewer side effects.
目的
本研究旨在比较5-氨基酮戊酸光动力疗法（ALA-PDT）与手术治疗癌前病变手术后复发性宫颈高级别鳞状上皮内病变（HSIL）的临床疗效和安全性。
方法
回顾性研究41例癌前病变手术后复发性宫颈HSIL患者。患者接受ALA-PDT或手术治疗，并在3、6、9和12个月时进行随访，之后每六个月随访一次。收集临床数据并比较两种治疗方法的疗效和安全性。
结果
在41例锥切术后复发性宫颈HSIL患者中，15例接受ALA-PDT治疗，26例接受手术治疗。在六个月的随访中，ALA-PDT组病变的完全缓解（CR）率为93.33%，手术组为88.46%。人乳头瘤病毒（HPV）清除率分别为66.67%和73.08%。两组之间在病变CR率和HPV清除率方面未观察到显著差异（P>0.05）。在十二个月的随访中，HPV清除率分别为80.00%和91.67%。两组之间在HPV清除率方面未观察到显著差异（P>0.05）。在手术组中，45岁以上患者的HPV清除率和病变CR率较低（25.00%对81.82%，P = ？0.031；50.00%对95.45%，P = ？0.052）。在随访期间，两组之间的复发率无显著差异（P>0.05）。此外，没有患者病情进展。在接受ALA-PDT治疗的女性中，没有阴道出血，与手术组相比，对宫颈组织结构或功能没有有害影响，并且两名女性在接受ALA-PDT治疗后成功分娩。
结论
ALA-PDT在治疗手术后复发性宫颈HSIL方面的疗效与手术相似，副作用较少。
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