比较CO₂激光和液氮冷冻预处理后联合5-氨基酮戊酸光动力疗法（ALA-PDT）治疗肛周尖锐湿疣的疗效及不良反应。

收集2016年1月至2022年6月于首都医科大学附属北京安贞医院皮肤科就诊的肛周尖锐湿疣患者共164例，年龄为[31（25，36）]岁，病程为[12（6，24）]周。随机数字法分为3组，对照组患者给予ALA-PDT治疗，CO₂激光预处理治疗组患者（CO₂组）给予CO₂点阵激光预处理联合ALA-PDT治疗，液氮冷冻预处理治疗组患者（冷冻组）给予液氮冷冻预处理后联合ALA-PDT治疗，根据患者的皮损数目及改善程度计算疗效，并采用卡方检验及率的U检验进行统计学分析。

完成治疗后3个月随访，对照组患者复发率（9.6%）高于CO₂组（1.8%）和冷冻组（1.8%），差异无统计学意义（U = 1.7749、P = 0.0759，U = 1.7749、P = 0.0759）；CO₂组和冷冻组患者复发率差异无统计学意义（U = 0.0000、P = 1.0000）。完成治疗后6个月随访，对照组中4例（8.51%）患者复发，CO₂组和冷冻组患者均无复发。治疗总体清除率对照组患者（91.49%）显著低于CO₂组（100%）和冷冻组（100%），且差异具有统计学意义（U = 0.0759、P = 0.0273，U = 0.0759、P = 0.0273）。CO₂组、冷冻组和对照组患者治疗后疼痛发生率分别为12.5%（7/56）、10.7%（6/56）和11.5%（6/52），差异无统计学意义（χ² = 0.6122、P = 0.0470）。CO₂组、冷冻组和对照组患者治疗后感染发生率分别为1.8%（1/56）、0.0%（0/56）和1.9%（1/52），差异无统计意义（Fisher’s确切概率法：P = 0.7654）。

CO₂激光预处理及液氮冷冻预处理联合ALA-PDT治疗肛周尖锐湿疣的疗效均优于单独ALA-PDT治疗，且并不增加不良反应发生率。

To investigate the effect and safety of CO₂ fractionnal laser and liquid nitrogen cryotherapy pretreatment combined with 5-aminolaevulinic acid-based photodynamic therapy (ALA-PDT) on the photodynamic therapy treatment of perianal condyloma acuminatum.

Total of 164 patients with perianal condyloma acuminatum were collected from January 2016 to June 2022 in the Department of Dermatology, Beijing Anzhen Hospital, Capital Medical University, aged 17-75 [31 (25, 36)] years old, disease course was 3-56 [12 (6, 24)] weeks. The patients were divided into 3 groups randomly, the control group was treated with ALA-PDT, the CO₂ laser pretreatment group (CO₂ group) was given CO₂ fractional laser pretreatment combined with ALA-PDT treatment, and the liquid nitrogen cryotherapy pretreatment treatment group (cryotherapy group) was given liquid nitrogen cryotherapy pretreatment combined with ALA-PDT treatment. The treatment effect was calculated according to the number of lesions and the degree of improvement of the patient, and the treatment effect was compared and analyzed by Chi-square test and U-test of rate.

During the follow-up of 3 months after treatment, the recurrence rate of control group (9.6%) was significantly higher than those of CO₂ group (1.8%) and cryotherapy group (1.8%), and without significant difference (U = 1.7749, P = 0.0759; U = 1.7749, P = 0.0759). There was no significant difference in recurrence rates between CO₂ group and cryotherapy group (U = 0.0000, P = 1.0000). During the follow-up of 6 months after treatment, 4 patients (8.51%) in control group relapsed, and there was no recurrence in both CO₂ group and cryotherapy group. The overall clearance rate of treatment was significantly lower in control group (91.49%) than those in CO₂ group (100%) and cryotherapy group (100%) (U = 0.0759, P = 0.0273; U = 0.0759, P = 0.0273). The incidences of pain after treatment in CO₂ group, cryotherapy group and control group were 7 (12.5%), 6 (10.7%) and 6 (11.5%), respectively, without significant difference (χ² = 0.6122, P = 0.0470). The incidences of infection after treatment in CO₂ group, cryotherapy group and control group were 1 (1.8%), 0 (0.0%) and 1 (1.9%), respectively, without significant difference (Fisher’s exact probability test: P = 0.7654).

For patients with perianal condyloma acuminatum, CO₂ laser and liquid nitrogen cryotherapy pretreatment combined with ALA-PDT were better than ALA-PDT alone, and did not increase the incidence of adverse reactions.