Digestive Disease Center, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
World J Gastroenterol. 2012 Oct 21;18(39):5589-94. doi: 10.3748/wjg.v18.i39.5589.
To evaluate the effect of photodynamic therapy (PDT) on metal stent patency in patients with unresectable hilar cholangiocarcinoma (CC).
This was a retrospective analysis of patients with hilar CC referred to our institution from December, 1999 to January, 2011. Out of 232 patients, thirty-three patients with unresectable hilar CC were treated. Eighteen patients in the PDT group were treated with uncovered metal stents after one session of PDT. Fifteen patients in the control group were treated with metal stents alone. Porfimer sodium (2 mg/kg) was administered intravenously to PDT patients. Forty-eight hours later, PDT was administered using a diffusing fiber that was advanced across the tumor by either endoscopic retrograde cholangiopancreatography or percutaneous cholangiography. After performance of PDT, uncovered metal stents were inserted to ensure adequate decompression and bile drainage. Patient survival rates and cumulative stent patency were calculated using Kaplan-Meier analysis with the log-rank test.
The PDT and control patients were comparable with respect to age, gender, health status, pre-treatment bilirubin, and hilar CC stage. When compared to control, the PDT group was associated with significantly prolonged stent patency (median 244 ± 66 and 177 ± 45 d, respectively, P = 0.002) and longer patient survival (median 356 ± 213 and 230 ± 73 d, respectively, P = 0.006). Early complication rates were similar between the groups (PDT group 17%, control group 13%) and all patients were treated conservatively. Stent malfunctions occurred in 14 PDT patients (78%) and 12 control patients (80%). Of these 26 patients, twenty-two were treated endoscopically and four were treated with external drainage.
Metal stenting after one session of PDT may be safe with acceptable complication rates. The PDT group was associated with a significantly longer stent patency than the control group in patients with unresectable hilar CC.
评估光动力疗法（PDT）对不可切除肝门部胆管癌（CC）患者金属支架通畅性的影响。
这是对 1999 年 12 月至 2011 年 1 月间我院收治的肝门部 CC 患者进行的回顾性分析。232 例患者中，33 例不可切除肝门部 CC 患者接受治疗。PDT 组 18 例患者在单次 PDT 后接受未覆盖金属支架治疗。对照组 15 例患者仅接受金属支架治疗。PDT 患者静脉内给予卟啉钠（2mg/kg）。48 小时后，通过内镜逆行胰胆管造影或经皮胆管造影术将扩散纤维推进肿瘤，进行 PDT。PDT 后，插入未覆盖的金属支架以确保充分减压和胆汁引流。采用 Kaplan-Meier 分析和对数秩检验计算患者生存率和累积支架通畅率。
PDT 组和对照组患者在年龄、性别、健康状况、治疗前胆红素和肝门部 CC 分期方面无差异。与对照组相比，PDT 组支架通畅时间显著延长（中位时间分别为 244±66d 和 177±45d，P=0.002），患者生存时间也更长（中位时间分别为 356±213d 和 230±73d，P=0.006）。两组早期并发症发生率相似（PDT 组 17%，对照组 13%），所有患者均接受保守治疗。PDT 组 17%（6/35）和对照组 13%（2/15）的患者发生支架功能障碍。在这 26 例患者中，22 例接受内镜治疗，4 例接受外部引流。
单次 PDT 后金属支架置入可能是安全的，并发症发生率可接受。与对照组相比，PDT 组在不可切除肝门部 CC 患者中具有更长的支架通畅时间。
