血管靶向光动力疗法治疗胃窦血管扩张症

Short-Term Efficacy of Vascular Targeted Photodynamic Therapy for Gastric Antral Vascular Ectasia

目的探索血管靶向光动力疗法治疗胃窦血管扩张症的可行性。方法胃窦血管扩张症合并出血患者1例,静脉注射光敏剂PSD-007 5 mg/kg后即刻,以波长630 nm的半导体激光先用柱状光纤照射胃窦病变20 min,再以点状光纤照射10 min,功率密度均为80～100 mW/cm^2,总能量密度144～180 J/cm^2。术后第1周及第5周复查胃镜,第5周进行近期疗效评价。并观察和记录术中和术后不良反应。结果治疗后病变处渗血停止,扩张毛细血管颜色明显变暗,黏膜明显水肿。术后第4天患者黑便消失,大便潜血阴性。术后1周胃镜检查见胃窦近端异常扩张毛细血管基本消失,远端黏膜见表浅溃疡。术后5周患者贫血情况明显改善,胃镜检查见胃窦近端异常扩张毛细血管基本消失,黏膜光滑、完整,患者大便潜血持续阴性。术后及术后均无不良反应发生。结论血管靶向光动力疗法治疗胃窦血管扩张症具有靶向选择性高,止血作用确切,起效快,疗效持久,安全无创等优点,但尚需大样本、前瞻性研究来进一步验证其安全性及有效性。

Objective To explore the possibility of vascular targeted photodynamic therapy（V-PDT） for gastric antral vascular ectasia（GAVE） treatment. Methods Immediately after intravenous injection of PSD-007 at 5 mg/kg body weight,the patients with GAVE were irradiated with 630 nm semiconductor laser at power density of 80-100 mW/cm.At first,a cylindrical fiber was used to irradiation for 20 minutes, then a point-like optical fiber was used for 10 minutes.The total energy density was 144-180 J/cm.Endoscopy examination was conducted to evaluate the short-term at 5 weeks after effect PDT. Immediately after V-PDT,endoscopic examination revealed the expanded capillary significantly darkened the color and stopped the bleeding,and gastric mucosa edema became more marked.Four days after V-PDT,black stool disappeared and occult test was negative.Endoscopic examination at 1 week after V-PDT showed abnormal expansion of capillaries of proximal gastic antrum almost disappeared,remote gastric antrum seen superficial ulcer formation.Anemia of the patients was significantly improved at 5 weeks after V-PDT.Endoscopic examination revealed abnormal expansion of capillaries of proximal gastric antrum almost disappeared.No adverse events were seen during and after PDT. Conclusions The preliminary study showed V-PDT could selectively destroyed the abnormal expanded capillaries of GAVE with rapid effect and suggesting V-PDT be an safe and effective treatment for GAVE.But it will take a large sample,prospecitve stuidies to further validate the feasibility.