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目的探讨影响5-氨基酮戊酸光动力疗法(ALA-PDT)治疗尖锐湿疣疗效的相关因素并随访了解其预后情况。方法回顾性分析78例尖锐湿疣患者应用ALA-PDT治疗的疣体清除情况,以清除疣体的治疗次数为应变量,疣体的个数、最大疣体的直径、最大疣体的面积、所有疣体的总面积以及是否应用过其他治疗、是否为尿道口的病变,进行多变量多元线性回归分析;并对治愈患者进行长达2年的随访。结果多元线性回归分析结果提示其治疗效果与疣体的最大直径呈正相关,而与纳入研究的其他因素无相关关系。78例患者中8例复发,5例治疗前多次应用过电灼及其他物理治疗的患者出现尿道狭窄。2年随访结束后,78例患者治疗部位均未出现异常隆起及凹陷、治疗部位的皮肤及黏膜颜色与周边皮肤及黏膜无差异;77%的患者对光动力治疗满意。结论影响ALA-PDT治疗尖锐湿疣的因素与单个疣体的最大直径相关,而与纳入其他因素无相关关系,即疣体的最大直径越大需要治疗的次数越多;2年的随访结果表明ALA-PDT疗效好,不良反应轻微,复发率低,安全性高,但对于治疗前曾多次应用过冷冻、电灼等物理治疗的患者应向其交代远期仍有发生尿道狭窄的风险。
Objective To investigate the factors that affect the efficacy of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of condyloma acuminatum and follow-up to understand its prognosis. Methods A retrospective analysis of 78 patients with condyloma acuminatum treatment with ALA-PDT removal of the wart to clear the number of treatment for the wart strain, the number of warts, the largest wart diameter, the largest wart area, all The total area of the warts and whether other treatments were applied were used for multivariate linear regression analysis of the urethral orifice lesions; and the cured patients were followed up for up to 2 years. The results of multiple linear regression analysis showed that the treatment effect was positively correlated with the maximum diameter of the wart, but not with other factors included in the study. Eight of the 78 patients relapsed, and five had urethral stricture in patients who had been repeatedly treated with electrocautery and other physical therapy before treatment. After 2 years of follow-up, there were no abnormal uplift and depression in the treatment site of 78 patients. There was no difference in skin and mucous color between the treated site and the surrounding skin and mucous membrane. 77% of the patients were satisfied with the photodynamic therapy. Conclusions The factors influencing ALA-PDT in the treatment of condyloma acuminatum are related to the maximum diameter of single wart, but not related to the inclusion of other factors, ie, the larger the maximum diameter of wart, the more times need to be treated. The 2-year follow-up results show that ALA- -PDT has good curative effect, mild adverse reactions, low recurrence rate and high safety. However, patients who have been treated with multiple physical treatments such as freezing and electrocautery before treatment should be accountable for the long-term risk of urethral stricture.