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目的:探讨降低肛管内尖锐湿疣复发率的治疗措施。方法:采用导流杂交基因芯片技术检测HPV基因分型。108例肛管内尖锐湿疣患者初次治疗为CO_2激光治疗去除疣体后,给予5-氨基酮戊酸光动力疗法(ALA-PDT),每周1次,共3次。末次治疗后随访6个月,复发患者再次CO_2激光治疗去除疣体后,给予ALA-PDT治疗,每周1次,共10次,结束后外用咪喹莫特乳膏,每周3次,共12周,随访6个月,观察临床疗效和复发率。结果:108例尖锐湿疣患者中HPV阳性者81例,阴性者27例,HPV感染率75.0%。一重HPV感染51例,占47.2%,一重感染中HPV 6型为30例,阳性检出率为27.8%,是主要的感染型别,HPV 11型21例,阳性检出率为19.4%。多重HPV感染30例,阳性检出率27.8%。所有患者经初次治疗后痊愈率为79.6%,有效率为100.0%,复发率为22.1%;对复发患者进行再次治疗后,痊愈率为52.7%,有效率为100.0%,复发率为20.0%,两次治疗之后总的复发率为2.6%(2/77)。结论:肛管内尖锐湿疣组织感染的HPV基因型别主要为HPV6、HPV11及HPV6+HPV11。CO_2激光联合ALA-PPT及外用咪喹莫特软膏治疗肛管内尖锐湿疣,可显著降低肛管内尖锐湿疣的复发率。
Objective: To explore the treatment of reducing the recurrence rate of condyloma acuminata in anus. Methods: HPV genotyping was detected by flow-through hybridization gene chip technique. One hundred and eight patients with condyloma acuminatum were treated with CO_2 laser to remove the wart, and 5-aminolevulinic acid photodynamic therapy (ALA-PDT) was given once a week for 3 times. Six months after the last treatment, relapsed patients were treated with CO_2 laser to remove the warts. ALA-PDT was given once a week for 10 times. After the end, imiquimod cream was applied three times a week for a total of 12 weeks, followed up for 6 months, observed the clinical efficacy and recurrence rate. Results: Among the 108 cases of condyloma acuminatum, 81 were HPV positive, 27 were negative, and the infection rate was 75.0%. One case of HPV infection was found in 51 cases (47.2%). Of the 30 cases of HPV infection in one case, the positive rate was 27.8%. The HPV infection was detected in 21 cases and the positive rate was 19.4%. Multiple HPV infection in 30 cases, the positive detection rate of 27.8%. The recovery rate of all the patients after initial treatment was 79.6%, the effective rate was 100.0% and the recurrence rate was 22.1%. After re-treatment of relapsed patients, the cure rate was 52.7%, the effective rate was 100.0% and the recurrence rate was 20.0% The overall recurrence rate after two treatments was 2.6% (2/77). Conclusion: HPV genotypes of condyloma acuminata tissue are mainly HPV6, HPV11 and HPV6 + HPV11. CO_2 laser combined with ALA-PPT and external imiquimod ointment for the treatment of anal warts can significantly reduce the recurrence rate of condyloma acuminata.