光動力醫學在牙醫學、婦科及神經外科的應用

Applications of Photodynamic Medicine in Dentistry, Gynecology and Neurosurgery

光動力醫學可區分為光動力診斷與光動力治療兩大類，目前已經被廣泛的運用在癌症的偵測與治療、抑制細菌或病毒引起的淺層感染。本文主要介紹光動力醫學在牙醫學、婦產科和神經外科的應用現況。在牙科方面，光動力治療可以減少細菌滋生進而達到降低細菌感染；應用於婦科疾病能夠有效治療人類乳突病毒相關之生殖器細胞異常、子宮頸上皮內贅瘤、以及外陰上皮內贅瘤和尖狀濕疣；在神經外科應用於惡性腦瘤包括多形神經膠母細胞瘤及分化不良星細胞瘤之手術與治療。開顱手術中以光感物質做螢光導引切除術可以有效的提高腦瘤的完成切除率；惡性腦瘤手術切除後配合光動力輔佐性治療已被證實是有效的，兩者均可增加病人存活率。此外，以光動力殺菌用來治療多重抗藥性綠膿桿菌亦是相當有效的方式，值得再繼續深入研究。

The clinical application of photodynamic medicine can be divided into diagnostic and therapeutic applications. It has been widely used in detection and treatment of certain malignancy and inhibition of bacterial or viral superficial infection. This article gives a brief review of its clinical application in dental, obstetrical, gynecological, and neurosurgical fields. In dental field, it can be used to decrease bacterial colonization and infection rate in periodontal diseases. In obstetrical and gynecological field, human papilloma virus-related dysplasia such as cervical and vulvar intraepithelial neoplasia, and condylomata acuminate can be treated using photodynamic therapy. In terms of neurosurgical applications, it is used in surgery and therapy for malignant brain tumors such as the glioblastoma multiforme and anaplastic astrocytoma. The use of fluorescence-guided resection method to guide surgical resection of these tumors can increase complete resection rate and the use of photodynamic therapy as adjuvant therapy has been shown to be effective, both lead to increase survival of these patients. In addition, the bactericidal effect of photodynamic therapy is an extremely effective therapy for multidrug resistant Pseudomonas aeruginosa infection which is worthy of further clinical research to widen its application.