直视下超级微创光动力疗法治疗胰腺导管内乳头状黏液肿瘤患者1例

Ultra-minimally Invasive Photodynamic Therapy of Pancreatic Intraductal Papillary Myxoma under Direct Vsion:a Case Study

目的探讨直视下超级微创光动力疗法(photodynamic therapy,PDT)治疗胰腺导管内乳头状黏液肿瘤的临床疗效。方法胰腺导管内乳头状黏液肿瘤(intraductal papillary mucinous neoplasm,IPMN)患者1例,采用肿瘤靶向层析光动力疗法新理念设计的临床方案,在静脉注射光敏剂血卟啉注射液1.5 mg/Kg后48 h,通过胆胰内镜置入发光长度为3 cm柱形光纤对胰管尾部和部分中部进行照射,激光波长532 nm,功率密度80 mW/cm^(2),照射时间为10 min,能量密度48 J/cm^(2)。激光照射结束后撤出光纤,再次超选胰管成功,沿导丝置入7F单猪尾塑料胰管支架。结果PDT治疗后即刻受照的病变区局部可见黏膜水肿、色略苍白、肿瘤内血管呈暗紫色,术中无出血。PDT术后第1天患者淀粉酶为1345 U/L、脂肪酶为5697 U/L,PDT术后第6天,淀粉酶、脂肪酶达到正常,术后患者无发热、恶心、呕吐,无腹胀、腹痛等不良反应发生。PDT术后第3天和第6天,CT检查结果胰腺形态及密度均未见异常。术后2个月行胆胰内镜可见胰尾部病变完全消失,胰管中部病变仅剩约1/4周乳头状结构,较治疗前环周占位明显改善。结论直视下超级微创PDT治疗胰腺导管内IPMN具有良好的安全性和有效性。

Objective To investigate the safety of ultra minimally invasive photodynamic therapy of pancreatic intraductal papillary myxoma under direct vision.Methods 1.5 mg/Kg photosensitizer hemoporphyrin injection was given intravenously.PDT treatment was performed 48 h after administration.The duodenoscope was inserted into the descending segment of the common bile duct,and the papilla showed postresection changes.The pancreatic duct was successfully selected with the guide wire carried by the bow knife.The angiography showed pancreatic duct dilation,filling defects in the middle and head of the pancreatic duct.After the bow knife was withdrawn,eyeMax-9 F type biliary and pancreatic endoscopy was inserted along the guide wire.The middle part of the pancreatic duct and the head of the pancreas were occupied under direct vision,and the middle part was circumferential and papillary.After the guide wire was removed,the laser fiber was implanted through biliary and pancreatic endoscopy.The treatment light parameters were wavelength532 nm,power density 80 mW/cm^(2),length of luminescent end of columnar fiber 3 cm,irradiation time 10 min,energy density 48 J/cm^(2).The treatment scope was the middle and tail of pancreatic duct.After the end of the treatment,the laser fiber was withdrawn,and the pancreatic duct was successfully selected again.A 7 F plastic pancreatic duct stent with pigtail was placed along the guide wire.Results Immediately after PDT treatment,the local mucosa in the lesion area had obvious water species,pale and dark purple color,and no intraoperative bleeding.1 day after PDT,amylase and lipase were 1345 U/L and 5697 U/L respectively.6 days after PDT,amylase and lipase reached normal value,and no obvious abnormality was found in physical examination.No fever,nausea,vomiting,abdominal distension,abdominal pain and other serious adverse reactions occurred.3 and 6 days after PDT,CT showed no abnormality in pancreas morphology and density.Two months after the operation,biliary and pancreatic endoscopy showed that only 1/4 papillary structure remained in the middle of the pancreatic duct during photodynamic therapy(compared with the peripheral space occupying detail before treatment),and the tail lesions completely disappeared.Conclusions The clinical safety of PDT in the treatment of IPMN under direct vision at 532 nm is good.