Zusammenfassung
Fluoreszenzdiagnostik und photodynamische Therapie mit 5-Aminolävulinsäure induziertem Protoporphyrin IX sind neue diagnostische und therapeutische Anwendungen in einem weiten Spektrum der Medizin wie der Urologie, Dermatologie, Gastroenterologie, Chirurgie, Neurochirurgie und Gynäkologie. Das Prinzip der Fluoreszenzdiagnostik basiert auf der exogenen Applikation der biochemischen-Vorstufe des Hämmoleküls 5-Aminolävulinsäure, die in bestimmten Zellen und Geweben die endogene Synthese und Akkumulation des Photosensibilisators Protoporphyrin IX induziert. Unter Anregung mit blauem Licht können so insbesondere maligne, prämaligne und proliferierende Läsionen über die charakteristische Rotfluoreszenz des Sensibilisators sichtbar gemacht werden. Die Fluoreszenzdiagnostik dient der Detektion auch kleinster pathologischer Gewebsveränderungen und kann den diagnostischen Wert anderer optischer Verfahren steigern. In der Gynäkologie sind in den letzten Jahren eine große Anzahl an Studien zur Fluoreszenzdiagnostik mit 5-Aminolävulinsäure durchgeführt worden. In dieser Arbeit soll auf die Grundlagen der Fluoreszenzdiagnostik und den gegenwärtigen Stellenwert dieser Methode der optischen Diagnostik im Bereich der Gynäkologie eingegangen und Optionen für das therapeutische Potenzial aufgezeigt werden.
Abstract
Fluorescence diagnosis and photodynamic therapy with 5-aminolevulinic acid induced protoporpyrin IX are promising new options in the diagnosis and therapy of diseases in a wide spectrum of medical disciplines such as urology, dermatology, gastroenterology, surgery, neurosurgery and gynecolgy. The techniques are based on the application of the heme biomolecule precursor 5-aminolevulinic acid which induces the endogenous accumulation of the photosensitizer protoporphyrin IX in designated tissues. After external excitation with blue light a strong red fluorescence can be initiated particulary in tumorous tissues. In gynecology many studies have been performed evaluating the usefulness of fluorescence based detection of cervical dysplasias, breast cancer, endometrial diseases, ovarian cancer and endometriosis. This work aims on the principles of fluorescence detection as an important tool in biomedical optical imaging and its current status in gynecology.
Schlüsselwörter
5-Aminolävulinsäure - Protoporphyrin IX - Fluoreszenzdiagnostik - photodynamische Therapie - Gynäkologie
Key words
5-aminolevulinic acid - protoporphyrin IX - fluorescence detection - photodynamic therapy - gynecology
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Dr. med. M. Löning
Klinik für Frauenheilkunde und Geburtshilfe · Universitätsklinikum Schleswig-Holstein Campus Lübeck
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