胆道恶性梗阻的光动力治疗疗效观察

Effect of Photodynamic Therapy for Malignant Obstruction of Biliary Tract

目的探讨光动力治疗对胆道恶性梗阻的疗效和安全性。方法回顾性分析我中心接受经皮光动力治疗的胆管恶性梗阻患者临床资料,根据是否联合介入、靶向或免疫治疗分为光动力组和联合组。观察治疗后肝功能变化、胆道通畅时间及术后1月内并发症。结果共入组19位患者,光动力治疗成功率达100%。术后1月未观察到肝功能下降。最长随访时间17.7月,术后1、3、6和12月胆道通畅率分别为100%、89.5%、72%和64%,平均胆道通畅时间约6.9±0.8月(95%CI:5.2~8.7月)。BismuthⅢ型胆道通畅时间7.5±1.1月,BismuthⅣ型胆道通畅时间6.1±1.3月。单纯光动力治疗组胆道通畅时间约3.3±0.7月,联合治疗组患者胆道通畅时间约7.9±0.9月,两组差异具有统计学意义(P=0.017)。结论光动力治疗BismuthⅢ-Ⅳ型胆道恶性梗阻安全有效,联合全身治疗可使胆道通畅时间显著延长。

Objective To investigate the safety and efficacy of photodynamic therapy(PDT)for malignant obstruction of the biliary tract.Methods We retrospectively analyzed the clinical data of patients with malignant biliary obstruction treated by PDT in our medical center.On the basis of different treatment plans,the patients were categorized into the photodynamic only group and the combined treatment group,in which additional interventional operations,targeted therapy,or immunotherapy were arranged.The alterations in liver function,duration of biliary patency,and postoperative complications that occurred within one month were closely monitored in both groups.Results A total number of 19 patients were enrolled in this study.The technical success rate of PDT was 100%.The deterioration of liver function was not observed in any patients within one month after PDT.Within a maximum of 17.7 months follow-up,the patency rates of the biliary tract were 100.0%,89.5%,72%,and 64%at 1,3,6,and 12 months after the procedure,respectively.The mean biliary patency time was 6.9±0.8 months(95%CI:5.2-8.7 months).Specifically,the biliary patency times for Bismuth typeⅢandⅣwere 7.5±1.1 and 6.1±1.3 months,respectively.The biliary patency time was around 3.3±0.7 months in the photodynamic only group and 7.9±0.9 months in the combined treatment group(P=0.017).Conclusion PDT for BismuthⅢ-Ⅳmalignant biliary obstruction is safe and effective.Moreover,the period of biliary patency is greatly extended when PDT is combined with systemic therapy.