Therapeutic effect of photodynamic therapy on 20 cases of condyloma acuminatum

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                                                          Huang Guojian   Chen Jing Jing he Zuxiu   Su Min  

  Guilin Hospital of traditional Chinese medicine, Guilin, Guangxi 541002, China

 

Objective to investigate the clinical effect of photodynamic therapy on condyloma acuminatum ( ). Methods 40 cases of   were randomly divided into treatment group and control group. In the control group, 20 cases were treated with CO2 laser. The treatment group of 20 cases were treated by photodynamic therapy PDT. The course of treatment was 1 months. Clinical cure and recurrence were observed in two groups. Results the curative effect of the treatment group was better than that of the control group, the difference was significant (P) ( ). Since April 2006, we have treated 20 cases of condyloma acuminatum with photodynamic therapy, and achieved satisfactory results. The results are reported as follows.

1                data and methods:

Clinical data; 1.1 

1.1.1  case selection   diagnostic criteria for clinical diagnosis of CA in clinical dermatology [1] diagnostic criteria. Inclusion criteria: meet the diagnostic criteria of [1] CA 1. In no other organ diseases, no secondary infection. The 30 day before treatment without systemic application of antiviral drugs and other drugs for external use. The non photosensitizer allergy or photosensitive skin disease; the voluntary acceptance of the treatment in the observation. Exclusion criteria: the photosensitizer allergy or photosensitive skin diseases. Treatment within 30 days prior to receiving antiretroviral drugs and other topical drug treatment; the liver and kidney dysfunction or other organ diseases and secondary infection; the waiver of treatment.

1.1.2  general data   all patients were outpatients of Department of dermatology in our hospital, a total of 40 cases were randomly divided into two groups. The treatment group of 20 cases, 14 cases were male, 6 were female; aged 18-57 years old, average 28.5 years old; the course of disease was 1 months to 4 years, the average (3.3 + 0.9); location: male penis root: 2 cases, 2 cases, middle dorsal coronary sulcus in 9 cases, 1 cases of lace. 5 cases of female genital labia minora and vaginal orifice, perianal in 1 cases. The shape of lesions: 1 cases of cauliflower in 17 cases, 2 cases of papillary, cristate.

Lesion size: 0.5~2.3cm. The number of lesions: 5~79, with an average of 28. The control group of 20 cases, 12 cases were male, 8 were female; aged 19-40 years old, average 26 years old; the course of disease was 1 months to 3 years, the average (2.5 + 1.1); location: male penis root: 1 cases, 3 cases, middle dorsal coronary sulcus in 6 cases, 2 cases of lace. 6 cases of female genital labia minora and vaginal orifice. Perianal 2 cases. The shape of lesions: 3 cases of 16 cases, 1 cases of papillary, cauliflower cristate. Lesion size: 0.2~2cm. The number of lesions: 3~31, with an average of 17. There were no significant differences in gender, age, course of disease and skin lesions in the two groups (P>0.05).

1.2  treatment: control group after routine disinfection, in and around 5% of the lesions with acetic acid, under local anesthesia received YIZ-3 CO2 laser J machine (Beijing Shuangqiao laser instrument factory made) treatment, so that all the warts completely carbonized, surgical range beyond all warts basal edge 2~3mm. Treatment group: the photosensitizer 5- aminolevulinic acid hydrochloride were (5-ALA) [Shanghai Institute of biological research production] according to the proportion, and then coated on the surface of the lesion, repeated 3 times, each time interval of 60 minutes, the lesions absorb enough ALA. Then the type PDT635AB photodynamic laser therapy instrument (developed in Guilin city of Xingda photoelectric medical instrument limited company), according to the 100~300mW/cm2 power density on the affected area under light treatment, each spot irradiation for 20 minutes. If the urethra or other luminal organs, cylindrical fiber can be used to implement irradiation. The 2 groups after treatment were without any drug, to ensure sleep, do not drink, during the treatment of different housing. To observe the curative effect on the treatment of first, 2, 3, 4 weeks, if not fall off or not all lesions, can be second, 3, 4 times of treatment. After the treatment 3~6 months to observe the recurrence.

1.3  curative effect evaluation criteria: (standard reference international CA to evaluate the effect of therapy) [2]: recovery: the wart disappeared, no new wart occurred during the original treatment site and its surrounding 5mm in follow-up; recurrence during follow-up in the original treatment site and its surrounding 5mm appeared in the new wart. The recurrence rate was calculated after the end of observation.

1.4  statistical methods: the recurrence rate of the two groups was statistically analyzed by x2 test.

2 Results: at the end of the observation group, the treatment group recovered in 20 cases (100%), with a recurrence of 0 cases. In the control group, 11 cases (55%) relapsed (45%) (n = 9). Table 1 curative effect and recurrence rate of the two groups. The recurrence rate of the two groups, the cure rate has significant difference (P, after treatment, no wound; local irradiation treatment with 2 cases of female patients with mild pain, then pain disappeared after irradiation, without any treatment. All the other patients. All the patients in the control group were treated with local anesthesia. There were no serious adverse reactions during the treatment of the two groups, and there were no significant changes in blood routine, liver and kidney function and electrocardiogram before and after treatment.

3 discussion

CA is a benign neoplasm of skin and mucosa caused by human papilloma virus, and there is a close relationship between genital cancer. In recent years, the disease is on the rise, the third place in the list of sexually transmitted diseases. At present many treatment methods, have a certain effect, but the recurrence rate is high, the CO2 laser is commonly used in the treatment of CA, but it can only be destructive treatment of visible warts, can not eliminate the latent infection and subclinical infection, the recurrence rate is high. PDT635AB photodynamic therapy for the treatment of CA, its curative effect. This machine is a continuous output wavelength of 635nm red semiconductor laser, equipped with a column type optical fiber and spherical dispersion optical fiber, optical fiber output power 300MW, fiber diameter not greater than 2.3mm, in 5- aminolevulinic acid hydrochloride were (5-ALA) for the treatment of photosensitive drug PDT, by irradiating the singlet oxygen containing a large number of lesions to produce sufficient quantities of photosensitizer caused by photochemical reaction strong, selective lesion tissue destruction for therapeutic purposes. Laser irradiation of pure 635nm wavelength has no damage to normal tissue. The PDT effect depends on pathological cell absorption of 5-ALA accumulation, characterized by the use of specific photosensitizer retention in the diseased tissue, give full play to the selective killing effect of PDT, do not injure the normal tissue is safe and well tolerated and normal tissue damage and other characteristics, to avoid the traditional CO2 laser, microwave, electric ion treatment cause pain, wound and other side effects. In this group, 2 cases of female patients with mild local pain, the end of radiation pain disappeared, there was no serious complications. Therefore, this method has the advantages of simple operation, strong specificity, less trauma, less side effects and lower cost. In this group, the laser output power was tested before and after laser treatment, and no power output decreased.

            problems and suggestions: because the photosensitizer coated to the lesion after three hours before photodynamic irradiation, patient waiting time is too long, not very convenient; improve and shorten photosensitive effect time, will be able to play a greater role in laser photodynamic therapy.

 

Reference

Zhao Zhao [1]. Clinical dermatology [M]. Third edition, Nanjing: Jiangsu science and Technology Press, 2001:604-607.

[2]van de Kerkhof assessment severity and alternative for of severity:persisting areas confusion[J].Br J Dermatol, 1997137 (4): 661-662. of (index) appyoaches, theassessment, of

 

 

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