Analysis of clinical efficacy of photodynamic and carbon dioxide laser in the treatment of vaginal intraepithelial neoplasia
-
摘要:
目的 分析阴道上皮内瘤变(VaIN)的临床特征，探讨光动力(ALA-PDT)与二氧化碳(CO2)激光治疗VaIN的临床疗效。 方法 选取2019年1月—2022年4月在蚌埠医学院第一附属医院经阴道镜下活检确诊为VaIN进行ALA-PDT的136例患者的临床资料，同时选取65例行CO2激光治疗的患者的临床资料，所有患者治疗后定期复查HPV、TCT，同时行阴道镜下活检，回顾性分析VaIN的临床特征，探讨ALA-PDT与CO2治疗VaIN的临床疗效。 结果 治疗结束后进行12个月随访，末次随访时，ALA-PDT组有85例(69.1%)实现HPV完全清除, CO2激光组有32例(51.6%)实现HPV完全清除，2组HPV清除率差异有统计学意义(P＜0.05)。随访期间，ALA-PDT组有112例(82.4%)病变完全清除，5例(3.7%)病变持续存在，12例(8.8%)部分缓解，3例(2.2%)进展，4例(2.9%)出现复发。CO2激光组有42例(64.6%)病变完全清除，3例(4.6%)病变持续存在，8例(12.3%)部分缓解，2例(3.1%)进展，10例(15.4%)出现复发。ALA-PDT组总体病变完全缓解率高于CO2激光组(P＜0.05)，ALA-PDT组复发率低于CO2激光组(P＜0.05)。ALA-PDT组有6例(4.4%)出现不良反应，CO2激光组有9例(13.8%)发生不良反应，ALA-PDT组不良反应发生率低于CO2激光组(P＜0.05)。 结论 ALA-PDT治疗VaIN病变完全缓解率更高，能有效清除HPV感染，不良反应少，复发率低，临床上值得进一步推广。 Abstract:Objective To retrospectively analyze the clinical characteristics of vaginal intraepithelial neoplasia (VaIN), and to evaluate the clinical effect of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) in the treatment of VaIN. Methods The clinical data of 136 patients diagnosed with VaIN by colposcopic biopsy who underwent ALA-PDT at the First Affiliated Hospital of Bengbu Medical College from January 2019 to April 2022 were selected, and the clinical data of 65 patients who underwent CO2 laser therapy were selected. HPV and TCT were regularly checked in all patients. At the same time, colposcopic biopsy was performed to retrospectively analyze the clinical characteristics of VaIN, explore the clinical efficacy of ALA-PDT treatment of VaIN, and compare with CO2 laser treatment. Results A 12-month follow-up was performed after the end of treatment. At the last follow-up, 85 cases (69.1%) in the ALA-PDT group and 32 cases (51.6%) in the CO2 laser group achieved complete HPV clearance. The HPV clearance rate was compared between the two groups, and the difference was statistically significant (P < 0.05). During the follow-up, 112 patients (82.4%) in the ALA-PDT group had complete clearance the lesions, 5 patients (3.7%) had persistent disease, 12 patients (8.8%) had partial remission, 3 patients (2.2%) had progression, and 4 patients (2.9%) had recurrence. In the CO2 laser group, 42 cases (64.6%) had complete remission, 3 cases (4.6%) persisted, 8 cases (12.3%)had partial remission, 2 cases (3.1%) progressed, and 10 cases (15.4%) recurred. The overall complete remission rate of lesions in ALA-PDT group was higher than that in the CO2 laser group, the difference was statistically significant (P < 0.05), and the recurrence rate in the ALA-PDT group was lower than that in the CO2 laser group, the difference was statistically significant (P < 0.05). There were 6 cases (4.4%) of adverse reactions in the ALA-PDT group and 9 cases (13.8%) in the CO2 laser group. The incidence of adverse reactions was lower in the ALA-PDT group than in the CO2 laser group, and the difference was statistically significant (P < 0.05). Conclusion ALA-PDT treatment of VaIN lesions has a higher complete remission rate, can effectively eradicate HPV infection, has fewer side effects, low recurrence rate, and merits further clinical promotion. -
Key words:
- Photodynamic /
- Carbon dioxide laser /
- Vaginal intraepithelial neoplasia /
- Clinical effect
-
表 1 201例VaIN患者临床特征
Table 1. Clinical characteristics of 201 VaIN patients
项目 例数(%) 项目 例数(%) 年龄(岁) 病灶分布部位 ≤50 110(54.7) 阴道上段 161(80.1) ＞50 91(45.3) 阴道下段 16(8.0) 绝经 阴道上段+下段 24(11.9) 自然绝经 56(27.9) 阴道镜病理 手术绝经 48(23.9) 低度病变 111(55.2) 未绝经 97(48.3) 高度病变 90(44.8) 病变发现方式 是否合并宫颈病变 阴道镜检查 181(90.0) 是 139(69.2) 盆腔检查 2(1.0) 否 62(30.8) 手术病理 18(9.0) 病变发现时子宫存在与否 治疗前是否合并HPV感染 是 138(68.7) 是 185(92.0) 否 63(31.3) 否 16(8.0) 
下载: 导出CSV
表 2 VaIN患者HPV清除和VaIN的完全缓解情况[例(%)]
Table 2. VaIN patients with HPV clearance and VaIN complete remission [cases (%)]
类别 ALA-PDT组 CO2激光组 例数 HPV清除 完全缓解 例数 HPV清除 完全缓解 VaINⅠ 74(54.4) 50(67.6) 61(82.4) 38(58.5) 17(47.2) 27(71.1) VaINⅡ 43(31.6) 26(60.5) 38(90.5) 16(24.6) 7(43.8) 9(56.3) VaINⅢ 19(14.0) 9(47.4) 13(68.4) 11(16.9) 8(72.7) 6(58.3) 合计 136 85(69.1) 112(82.4) 65 32(51.6) 42(64.6)
下载: 导出CSV
表 3 2组VaIN患者HPV清除和VaIN的病理缓解情况比较(例)
Table 3. Comparison of HPV clearance and VaIN pathological remission in two groups of VaIN patients (cases)
组别 例数 HPV清除 完全缓解 部分缓解 持续 进展 复发 ALA-PDT组 136 85 112 12 5 3 4 CO2激光组 65 32 42 8 3 2 10 χ2值 5.426 7.724 0.596 5.416 0.138 10.509 P值 0.020 0.005 0.440 0.020 0.711 0.001
下载: 导出CSV
-
[1] DONG H, LI H Y, WANG L M, et al. Clinical analysis of 175 cases of vaginal intraepithelial neoplasia[J]. Eur J Obstet Gynecol Reprod Biol, 2023, 287: 232-236. doi: 10.1016/j.ejogrb.2023.06.020 [2] 王亚飞, 王立群, 叶国柳. 阴道上皮内瘤变的临床特征及治疗和预后分析[J]. 中华全科医学, 2023, 21(7): 1134-1137, 1237. doi: 10.16766/j.cnki.issn.1674-4152.003067WANG Y F, WANG L Q, YE G L. Clinical features, treatment and prognosis of vaginal intraepithelial neoplasia[J]. Chinese Journal of General Practice, 2023, 21(7): 1134-1137, 1237. doi: 10.16766/j.cnki.issn.1674-4152.003067 [3] 楼伟珍, 陈飞, 杨旎, 等. 光动力疗法在女性下生殖道疾病中的临床应用[J]. 中国实用妇科与产科杂志, 2018, 34(11): 1300-1304. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201811031.htmLOU W Z, CHEN F, YANG N, et al. Photodynamic therapy in the female genital tract diseases under the clinical application[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2018, 34(11): 1300-1304. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201811031.htm [4] QU Z Y, WANG Z F, QIU S K, et al. Efficacy of photodynamic therapy with 5-aminolevulinic acid for the treatment of cervical high-grade squamous intraepithelial lesions with high-risk HPV infection: a retrospective study[J]. Photodiagnosis Photodyn Ther, 2022, 40: 103068. DOI: 10.1016/j.pdpdt.2022.103068. [5] IACOBONE A D, RADICE D, GUERRIERI M E, et al. Which Risk factors and colposcopic patterns are predictive for high-grade VAIN? A retrospective analysis[J]. Diagnostics(Basel), 2023, 13(2): 176. [6] ROUNTIS A, PERGIALIOTIS V, TSETSA P, et al. Management options for vaginal intraepithelial neoplasia[J]. Int J Clin Pract, 2020, 74(11): e13598. DOI: 10.1111/ijcp.13598. [7] YU D K, QU P P, LIU M H. Clinical presentation, treatment, and outcomes associated with vaginal intraepithelial neoplasia: a retrospective study of 118 patients[J]. J Obstet Gynaecol Res, 2021, 47(5): 1624-1630. doi: 10.1111/jog.14733 [8] 林艳华, 谢芳, 黄梅秀, 等. 阴道上皮内瘤变的回顾性分析[J]. 中国医药指南, 2021, 19(35): 46-48. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK202135017.htmLIN Y H, XIE F, HUANG M X, et al. Clinical analysis of vaginal intraepithelial neoplasia[J]. Guide of China Medicine, 2021, 19(35): 46-48. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK202135017.htm [9] AO M Y, ZHENG D X, WANG J W, et al. A retrospective study of cytology and HPV genotypes results of 3229 vaginal intraepithelial neoplasia patients[J]. J Med Virol, 2022, 94(10): 737-744. [10] ZHANG S, SAITO M, OKAYAMA K, et al. HPV Genotyping by molecular mapping of tissue samples in Vaginal Squamous Intraepithelial Neoplasia (VaIN) and Vaginal Squamous Cell Carcinoma (VaSCC)[J]. Cancers(Basel), 2021, 13(13): 3260. [11] GURUMURTHY M, LEESON S, TIDY J, et al. UK national survey of the management of vaginal intraepithelial neoplasia[N]. J Obstet Gynaecol, 2020, 40(5): 694-698. doi: 10.1080/01443615.2019.1652887 [12] ZHANG Y Y, XIA R, CHEN D, et al. Analysis of related factors of cervical intraepithelial neoplasia complicated with vaginal intraepithelial neoplasia[J]. Clin Transl Oncol, 2022, 24(5): 902-908. doi: 10.1007/s12094-021-02739-x [13] 徐晶, 屈清华, 刘宝, 等. 不同方法治疗阴道上皮内瘤变Ⅱ级合并高危HPV感染的临床疗效分析[J]. 中国病原生物学杂志, 2021, 16(12): 1470-1473. https://www.cnki.com.cn/Article/CJFDTOTAL-ZISC202112023.htmXU J, QU Q H, LIU B, et al. Analysis of the clinical effectiveness of different methods of treating gradeⅡvaginal intraepithelial neoplasia and a high-risk HPV infection[J]. Journal of Pathogen Biology, 2021, 16(12): 1470-1473. https://www.cnki.com.cn/Article/CJFDTOTAL-ZISC202112023.htm [14] 蔡卉苒, 邢燕. 全子宫切除术后阴道残端上皮内瘤变临床诊治进展[J]. 临床误诊误治, 2022, 35(1): 112-116. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWZ202201025.htmCAI H R, XING Y. Progress in the clinical diagnosis and treatment of intraepithelial neoplasia of vaginal stump after total hysterectomy[J]. Clinical Misdiagnosis & Mistherapy, 2022, 35(1): 112-116. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWZ202201025.htm [15] 孔东丽, 李双. 二氧化碳激光气化治疗下生殖道高级别鳞状上皮内病变的要点难点[J]. 实用妇产科杂志, 2021, 37(12): 892-894. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202112005.htmKONG D L, LI S. Key points and difficulties of carbon dioxide laser gasification in the treatment of high-grade squamous intraepithelial lesions of lower genital tract[J]. Journal of Practical Obstetrics and Gynecology, 2021, 37(12): 892-894. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202112005.htm [16] LIU T, MA X R, OUYANG T X, et al. Efficacy of 5-aminolevulinic acid-based photodynamic therapy against keloid compromised by downregulation of SIRT1-SIRT3-SOD2-mROS dependent autophagy pathway[J]. Redox Biol, 2019, 20: 195-203. doi: 10.1016/j.redox.2018.10.011 [17] ZHANG Y C, SU Y H, TANG Y J, et al. Comparative study of topical 5-aminolevulinic acid photodynamic therapy (5-ALA-PDT) and surgery for the treatment of high-grade vaginal intraepithelial neoplasia[J]. Photodiagnosis Photodyn Ther, 2022, 39: 102958. DOI: 10.1016/j.pdpdt.2022.102958. [18] HE M Y, YU E L, HUI S K, et al. Clinical outcomes of laser vaporization for vaginal intraepithelial neoplasia: a 20-year retrospective review[J]. Eur J Obstet Gynecol Reprod Biol, 2022, 277: 101-109. doi: 10.1016/j.ejogrb.2022.08.017 [19] YAO H X, ZHANG H Y, PU X W, et al. Photodynamic therapy combined with carbon dioxide laser for low-grade vaginal intraepithelial neoplasia: a retrospective analys[J]. Photodiagnosis Photodyn Ther, 2020, 30: 101731. DOI: 10.1016/j.pdpdt.2020.101731. [20] 杨光, 吴寒舒, 朱颐, 等. 氨基酮戊酸光动力治疗阴道上皮内瘤变的价值初探[J]. 中国临床保健杂志, 2022, 25(5): 692-695. https://www.cnki.com.cn/Article/CJFDTOTAL-LZBJ202205026.htmYANG G, WU H S, ZHU Y, et al. Preliminary study on the value of aminolevulinic acid photodynamic therapy for vaginal intraepithelial neoplasia[J]. Chinese Journal of Clinical Healthcare, 2022, 25(5): 692-695. https://www.cnki.com.cn/Article/CJFDTOTAL-LZBJ202205026.htm [21] 王阳阳, 张云凤, 牟婧祎, 等. 二氧化碳激光与光动力治疗阴道上皮内瘤变患者的临床疗效对比分析[J]. 实用妇产科杂志, 2022, 38(7): 520-524. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202207012.htmWANG Y Y, ZHANG Y F, MOU J Y, et al. Comparative analysis of efficacy of carbon dioxide laser and photodynamic therapy for vaginal intraepithelial neoplasia[J]. Journal of Practical Obstetrics and Gynecology, 2022, 38(7): 520-524. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202207012.htm -
点击查看大图
表(3)
计量
- 文章访问数: 293
- HTML全文浏览量: 110
- PDF下载量: 13
- 被引次数: 0
