冷冻联合ALA光动力疗法治疗肛周尖锐湿疣的疗效观察

目的比较冷冻和5-氨基酮戊酸光动力疗法（5-aminolevuline acid-photodynamic therapy,ALA-PDT）联合冷冻2种治疗措施,寻求一种使肛周尖锐湿疣复发率降低的途径。方法肛周尖锐湿疣52例,随机分为2组,每组26例,冷冻组每7∽10 d治疗1次,共治疗2∽6次。联合组皮损区涂20%ALA乳膏3 h后,以激光发射器照射,照射距离40 mm∽80 mm,照射时间为20 min,能量95∽102 J/cm2,间隔7∽10 d治疗一次,共治疗3次。冷冻1∽5 min后行光动力治疗。治疗后随访3∽12个月。结果 2组患者治疗后疣体完全清除,冷冻组复发率为38.5%,平均复发时间为31.7 d。联合复发率为7.7%,平均复发时间为62.1 d。结论 ALA-PDT联合冷冻治疗肛周的尖锐湿疣,能显著降低复发率（P〈0.01）,且创伤小、毒性低,选择性好。

Combination of photodynamic therapy with cryotherapy in treatment of perianal condyloma acuminatum

Objective To evaluate the efficacy of combination of 5-aminolevuline acid-photodynamic therapy （ALA-PDT） with cryotherapy in treatment of perianal condyloma acuminatum （CA）. Methods Fifty two patients with perianal condyloma acuminatum were randomly assigned to cryotherapy group and combination group with 26 cases in each group. Patients in cryotherapy group received total 2 - 6 cryotherapy with an interval of 7 - 10 d. Patients in combination group received additional photodynamic therapy after cryotherapy. Lesions were coated with 20% ALA cream, after 3 h the laser irradiation was given, with a distance of 40 - 80 mm and energy 95 - 102 J/cm2 for 20 min. The interval of therapy was 7 - 10 d for 3 times. Patients were followed up for 3 - 12 months after treatment. Results The warts all disappeared after treatment in both groups. The recurrence rate in cryotherapy and combination groups was 38.2% and 6.7% ; the average recurrence intervals were 31.7 d and 62.1 d, respectively （P 〈 0.01 ）. Conclusion The combination therapy of ALA-PDT with cryotherapy can significantly reduce the recurrence of perianal condyloma acuminatum, with less trauma, low toxicity and good selectivity.