Liu Yu, Li Ruizhen, Li Changzhong, Wu Ruifang
Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, PR China.
Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, PR China.
Photodiagnosis Photodyn Ther. 2025 Jun;53:104544. doi: 10.1016/j.pdpdt.2025.104544. Epub 2025 Mar 7.
This review aims to compare the effectiveness of photodynamic therapy (PDT) with conization, including loop electrosurgical excision procedure (LEEP) and cold-knife conization (CKC), in treating cervical high-grade squamous intraepithelial lesions (HSIL).
PubMed, Cochrane Library, Google Scholar, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched. The outcomes assessed were complete response (CR) rate, human papillomavirus (HPV) eradication rate, recurrence rate, and adverse events (AEs).
9 studies were included. A total of 312 patients received PDT, while 380 underwent conization (LEEP/CKC). There was no significant difference between PDT and conization in the CR rate at 3-6 months (OR: 1.64 [0.97, 2.76]; P = 0.06), 12-month CR (OR: 0.49 [0.13, 1.90]; P = 0.30), HPV eradication rate at 3-6 months (OR: 1.40 [0.95, 2.07]; P = 0.09), HPV eradication rate at 12 months (OR: 0.92[0.47, 1.82]; P = 0.81), or 12-month recurrence rate (OR: 2.97 [0.62, 14.25]; P = 0.17). However, the rate of AEs, including vaginal bleeding (OR: 0.10 [0.03, 0.33]; P = 0.0002), cervical canal adhesion (OR: 0.16 [0.03, 0.90]; P = 0.04), and cervical scar formation (OR: 0.04 [0.01, 0.30]; P = 0.002), was significantly lower with PDT than with conization. The degree of heterogeneity was not high.
Based on our systematic review and meta-analysis, it could be concluded that PDT may be a practical approach for cervical HSIL regression compared to conization (LEEP/CKC). However, further high-quality, controlled trials are needed to confirm these findings.
本综述旨在比较光动力疗法（PDT）与锥切术（包括环形电切术（LEEP）和冷刀锥切术（CKC））在治疗宫颈高级别鳞状上皮内病变（HSIL）方面的有效性。
检索了PubMed、Cochrane图书馆、谷歌学术、Embase、中国知网（CNKI）和万方数据。评估的结果包括完全缓解（CR）率、人乳头瘤病毒（HPV）清除率、复发率和不良事件（AE）。
纳入9项研究。共有312例患者接受了PDT，380例接受了锥切术（LEEP/CKC）。PDT与锥切术在3 - 6个月时的CR率（OR：1.64 [0.97, 2.76]；P = 0.06）、12个月时的CR率（OR：0.49 [0.13, 1.90]；P = 0.30）、3 - 6个月时的HPV清除率（OR：1.40 [0.95, 2.07]；P = 0.09）、12个月时的HPV清除率（OR：0.92[0.47, 1.82]；P = 0.81）或12个月时的复发率（OR：2.97 [0.62, 14.25]；P = 0.17）方面无显著差异。然而，PDT组的不良事件发生率，包括阴道出血（OR：0.10 [0.03, 0.33]；P = 0.0002）、宫颈管粘连（OR：0.16 [0.03, 0.90]；P = 0.04）和宫颈瘢痕形成（OR：0.04 [0.01, 0.30]；P = 0.002）明显低于锥切术组。异质性程度不高。
基于我们的系统评价和荟萃分析，可以得出结论，与锥切术（LEEP/CKC）相比，PDT可能是使宫颈HSIL消退的一种实用方法。然而，需要进一步的高质量对照试验来证实这些发现。
