光动力疗法治疗鲜红斑痣1216例临床分析

目的：分析比较血啉甲醚（HMME）与血卟啉衍生物（HpD)为光敏剂行光动力疗法（PDT）鲜红斑痣的临床疗效及副反应。材料与方法：鲜红斑痣患者1216例，粉红型13．2％，紫红型68．3％，增厚型18．4％。静脉注射HpD或HMME3－7mg/kg后给予铜蒸气激光、KTDS／532激光或氩离子激光照射，功率密度50－100mW/cm^2，能量密度90－540J／cm^2，随访观察。结果：HMME－PDT和HpD－PDT对各型鲜红斑痣均能有效地消除病变颜色，所随访的1632个病灶在2个月至9年的随访期内末见复发。治疗后反应有：局部水肿5－7天，部分患者有结痂或一过性色素沉着，皮肤暂时性光过敏反应。HpD－PDT组避光期30－90天，HMME－PDT组占光期7－14天，与HpD－PDT相比，HMME－PDT具有反应轻、愈合快、不衣反应少，安全度大、避光期短、色素沉着轻、护理容易、重复治疗间隔期短的特点。结论：HMME－PDT与HpD－PDT都能有效治疗各型鲜红斑痣，但HMME－PDT具有不良反应少、安全度大，避光期短、护理容易、重复治疗间隔期短等优点。

A Clinic Analysis of 1 216 Cases of Port Wine Stain Treated by Photodynamic Therapy

Objective To compare the clinic characteristics of a new kind of photosensitizer hematoporphyrin monomethyl ether(HMME) which can be quickly eliminated from body and has shorter period of skin photosensitivity with HpD in PWS treatment. Methods 1 216 PWS patients with 13 2% pink, 68 3% purple and 18 4% thickened type were irradiated by copper vapor laser, KTP/532 laser or Argon laser with power densities from 50 to 100 mW/cm 2 and energy densities from 90 to 540 J/cm 2 after 3 to 7mg/kg HMME or HpD intravenous injection. Results Results revealed that both HMME PDT and HpD PDT were able to cure all types of PWS and yielded similar color faded therapeutic effects. The follow up for 1 632 treated lesions were made from 2 months to 9 years following treatment. No instance of recurrence was found. The reactions and healing procedures after the treatment included 5 to 7 days local edema, scab formation in some cases, local transitorypigmentation in part patients and temporary skin photosensitivity which required patients avoiding strong light exposure for 30 to 90 days after using HpD and only 7 to 14 days by using HMME. Compared to HpD PDT, HMME PDT had advantages of minor local reations, faster healing prodecures, less unexpected results, safer usage, shorter period of skin photosensitivity, slighter pigmentation, easier nurse and shortened repeated treatment interval. Conclusions HMME PDT was similar to HpD PDT in clinical therapeutic effectiveness, but had better selective effect and shorter skin photosensitive period than HpD PDT.