Objective To compare the efficacy of systematic photodynamic therapy(S-PDT)and loop electrosurgical excision procedure(LEEP)in treating high grade squamous intraepithelial lesion(HSIL)and the clearance rates of high-risk human papillomavirus(HR-HPV)infection of the two methods.Methods A retrospective analysis on the clinical data of 32 CIN Ⅱ-Ⅲ patients given S-PDT in the Hainan Hospital of the PLA General Hospital and 168 CIN Ⅱ-Ⅲ patients given loop electrosurgical excision procedure(LEEP)in the Shenzhen Hospital of Peking University between Jan.2022 and Jan.2024 was conducted.Upon the screening by certain criteria and propensity score matching,the matched patients were divided into two groups:S-PDT group and LEEP group.In the S-PDT group,the patients were given S-PDT treatment,which involved the intravenous injection of the photosensitizer hematoporphyrin 48-72 hours before the procedure and the laser irradiation with a power density of 100 mW/cm2,a spot diameter of 3-4 cm,an irradiation time of 20-30 minutes and an energy density of 120-180 J/cm2.The patients in the LEEP group underwent LEEP treatment.Three to six months after the treatment,a thinprep cytologic test(TCT)was performed for the patients.Once the TCT results indicated the presence of CIN risk,colposcopy-guided biopsy of the cervical tissue was conducted for histopathological examination to assess the clinical efficacy.Additionally,HPV-DNA virological testing was performed on the cervical secretions of the patients.The adverse reactions and complications that occurred during the treatment period were also documented for both groups of patients.Results The propensity score matching resulted in a total of 62 matched CIN Ⅱ-Ⅲ patients,including 31 patients in the S-PDT group and 31 patients in the LEEP group.The comparison between the two groups showed no statistically significant difference in age or HR-HPV infection status(P＞0.05),indicating baseline equivalence.Three to six months after the treatment,both the S-PDT and LEEP groups exhibited a complete remission rate of 77.4％with an effective rate of 96.8％and 89.1％respectively,and the difference between the two groups was not statistically significant(P＞0.05).Additionally,the HR-HPV clearance rate(87.1％)in the S-PDT group was higher than that(64.5％)in the LEEP group three to six months after the treatment,and the difference was significant(P＜0.05).No severe adverse reaction was observed in either group during the treatment.None of such complications as bleeding,scarring,cervical stenosis and adhesions occurred in the S-PDT group 3-6 months after the treatment.Conclusions The results of this study demonstrate that S-PDT treatment for CIN Ⅱ-Ⅲ is a safe and highly targeted therapeutic approach that will effectively avoid damage to cervical structure and functions and hence preserve the integrity of the cervical tissue and organ.Additionally,S-PDT exhibits a favorable clearance effect on HR-HPV infection.
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