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目的: 探讨5-氨基酮戊酸光动力疗法(5-Aminolevulinic acid - photodynamic therapy, ALA-PDT)治疗尿道尖锐湿疣的临床疗效,并对治疗后皮损的组织病理学变化进行研究。方法:对164 例尿道尖锐湿疣患者进行了ALA-PDT治疗;并对11例外生殖器尖锐湿疣ALA-PDT治疗后的16个皮损进行了组织病理和超微研究。结果:164例患者经ALA-PDT治疗后,156例疣体完全消失,治愈率高达95.12%,而复发率仅5.13%(8/156);无感染、溃疡、疤痕和尿道狭窄等副作用。治疗后1、3 h时表皮浅层角质形成细胞变性坏死,5 h时表皮全层角质形成细胞坏死;电镜下发现治疗后1、3 h时线粒体一端肿胀、嵴断裂、内质网膜结构断裂、角质形成细胞变性和坏死、典型的细胞凋亡小体,5 h时大量角质形成细胞变性、坏死。结论:ALA-PDT是治疗尿道尖锐湿疣的简单、安全、有效、低复发率、耐受性好、无明显副作用的一种新疗法。ALA-PDT对尖锐湿疣的治疗作用是通过细胞凋亡和坏死两种途径实现的。
Objective: To investigate the clinical efficacy of 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of urethral condyloma acuminatum, and to study the histopathological changes of the lesions after the treatment. Methods: A total of 164 patients with urethral condyloma acuminatum were treated with ALA-PDT. Twenty-six lesions of 11 patients with genital warts treated with ALA-PDT were studied by histopathology and ultrastructure. Results: After treatment with ALA-PDT, 156 cases of wart completely disappeared. The cure rate was 95.12% and the recurrence rate was only 5.13% (8/156). No side effects such as infection, ulcer, scar and urethral stricture were observed. Epidermal superficial keratinocytes were denatured and necrotic at 1 and 3 h after treatment, and necrosis of epidermal keratinocytes was observed at 5 h. At 1 h and 3 h after treatment, mitochondria were swollen, cristae and endoplasmic reticulum were disrupted , Keratinocyte degeneration and necrosis, typical apoptotic bodies, a large number of keratinocytes degeneration and necrosis 5 h. Conclusions: ALA-PDT is a new therapy for the treatment of urethral condyloma acuminatum which is simple, safe, effective, low recurrence rate, well tolerated and has no obvious side effects. The therapeutic effect of ALA-PDT on condyloma acuminatum is achieved through both apoptosis and necrosis pathways.