光动力疗法治疗乳房外Paget病临床研究

目的 探讨荧光诊断指导下光动力治疗肛周皮肤湿疹样癌的临床意义。方法 肛周Paget病6例，前期3例行普通光动力治疗(PDT)，后期3例行荧光诊断指导下光动力治疗，普通PDT组给以光敏剂Photofrin 2mg/kg，48h后给以功率100～150mW /cm2、能量密度150～300J/cm2，波长630 nm半导体激光照射病灶；荧光诊断指导PDT组（FPDT）给以局部20％ALA湿敷（激光照射前3h）和静脉给光敏剂喜泊分5mg/kg（激光照射前48h），并给以同样剂量激光照射，激光照射前给以405nm蓝紫光行荧光诊断确定病灶的范围以指导治疗。治疗后48h和72h， 1、3和6个月观察患者病灶局部反应并长期随访。结果 治疗后48h 2组均可见病灶局部明显变暗、发黑、变硬，120h局部开始结痂，渗出减少，皮肤修复时间长。治疗后6个月普通PDT组CR1例，PR2例；FPDT组CR2例，PR1例。结论　光动力学疗法是肛周Paget病的有效治疗方法，荧光诊断对于确定病灶范围、指导临床治疗意义重大。

Photodynamic therapy in the treatment of extramammary Paget’s disease

Objective To observe the therapeutic effect of photodynamic therapy(PDT) for patients with perianal Paget’s disease guided by photodynamic fluorescence diagnosis. Methods　3 cases of 6 perianal Paget’s disease were treated by PDT alone, and the other 3 cases were treated by PDT guided by photodynamic fluorescence diagnosis. Routine PDT to utilize DIOMED 630nm diode laser as light source and Photofrin as photosensitizer. The patient’s focus was irradiated 48h after Photofrin 5mg/kg administration. The power density was 150～300J/cm2 and energy density was 100～150mW /cm2. PDT guided by photodynamic fluorescence diagnosis (FPDT group) was given the same dosage of Photofrin 48h before laser irradiation and 20% ALA local hydropathic compress 3h before laser irradiation. The laser dosage was the same as common PDT. The difference was that photodynamic fluorescence diagnosis guided to reassure the region of the cancer before laser irradiation. The observation of the reaction of the patients’ lesion change were taken in 48h, 72h, 1M, 3M and 6M after PDT and the follow up were continuing. Results The focus darkened and exudated apparently 48h after irradiation and formed a scar 120h gradually after irradiation. There were 1 case CR and 2 cases PR in common PDT, 2 cases CR and 1 case PR in FPDT 6 months after PDT. Conclusions Photodynamic therapy is an effective modality for perianal Paget’s disease, and fluorescence diagnosis is a key method to instruct clinical PDT by assurance the area of the lesion.