机械磨削术联合氨基酮戊酸光动力疗法治疗手部Bowen病

布文博 张珂 张倩

[摘要]目的：探讨机械磨削术联合氨基酮戊酸光动力疗法（ALA-PDT）治疗手部Bowen病疗效。方法：10例经病理确诊的手部Bowen病患者，均行机械磨削术联合ALA-PDT治疗。磨削时从外向里进行磨削，磨至弥漫性出血为止。后将氨基酮戊酸配成20%溶液涂于皮损及外周0.5cm，3～4h后行635nm红光照射，能量密度为80～100J/cm2，时间20min，每周照射1次，共3次。6个月后观察肿瘤有无复发，患者满意度及瘢痕形成等情况。结果：10例患者行机械磨削联合ALA-PDT治疗后，至少随访6个月，均未见肿瘤复发;10例患者均非常满意，治疗后无明显瘢痕增生。结论：机械磨削术联合ALA-PDT治疗手部Bowen病安全高效，痛苦小，创伤轻，患者满意度高，无明显瘢痕形成，值得临床推广。

[关键词]Bowen病;手部;机械磨削术;氨基酮戊酸;光动力疗法

[中图分类号]R739.5    [文献标志码]A    [文章编号]1008-6455（2020）04-0007-03

Abstract： Objective  To investigate the efficacy of mechanical dermabrasion combined with aminolevulinic acid-based photodynamic therapy（ALA-PDT）for the treatment of Bowen's disease of hands. Methods  Ten patients with Bowen's disease of band were treated by mechanical dermabrasion and ALA-PDT. Grinding was carried out from the outside to the inside until diffuse hemorrhage. After that， the wound surface and peripheral area of 0.5cm was topically treated with 20% aminolevulinic acid solution for 3-4 hours away from light immediately after surgery， then irradiated with red light at a mean dose of 80-100J/cm2 for 20 minutes. After 6 months， the tumor recurrence， patients' satisfaction and scar formation were observed. Results  Ten patients were followed up at least six months after mechanical dermabrasion combined with photodynamic therapy， no tumor recurrence was found. All patients were very satisfied and no patients had obvious scar hyperplasia. Conclusion  Mechanical dermabrasion combined with ALA-PDT is safe and effective in the treatment of Bowen's disease of hands， with little pain， light trauma， high patients' satisfaction and no obvious scar， which is worthy of clinical promotion.

Key words： Bowen's disease; hand; mechanical dermabrasion; aminolevulinic acid; photodynamic therapy

Bowen病（Bowen's disease，BD）亦称原位鳞状细胞癌，是一种早期皮肤原位癌，发生于皮肤或黏膜的表皮内，1912年由Bowen报道[1]。Bowen病临床常规治疗以手术扩大切除为主，也可采用微波、冷冻、光动力等方法治疗。手部Bowen病手术面临的问题是扩大切除后创面难以缝合，植皮或皮瓣修复后期瘢痕形成，影响美观等。光动力治疗由于肿瘤表面角质较厚及药物渗透深度有限等，可导致治疗效果欠佳及复发率高等问题。2015年3月-2019年6月，笔者科室采用机械磨削术联合氨基酮戊酸光动力疗法治疗10例手部Bowen病患者，术后随访6～57个月，肿瘤均无复发，患者满意度高，无明显瘢痕形成，取得了很好的临床疗效。

1  资料和方法

1.1 一般资料：选择2015年3月-2019年6月在笔者科室进行机械磨削术联合氨基酮戊酸光动力疗法治疗的10例手部Bowen病患者作为研究对象。……