McCaughan J S, Hawley P C, LaRosa J C, Thomas J H, Hicks W J
Grant Laser Center, Laser Medical Research Foundation, Columbus, Ohio 43215, USA.
Lasers Surg Med. 1996;19(4):492-4. doi: 10.1002/(SICI)1096-9101(1996)19:4<492::AID-LSM17>3.0.CO;2-4.
Photodynamic therapy (PDT) was used to stop life-threatening hemoptysis from bleeding hereditary telangiectasia in bronchi in a 42-year-old man with a 4-year history of repeated embolotherapies, tracheostomies, and ventilator dependence. At the time of his first PDT, he was 10 days past his third embolotherapy, was being ventilated through a tracheostomy and bringing up 100-200 cc of blood daily, necessitating multiple transfusions of blood and platelets.
STUDY DESIGN/MATERIAL AND METHODS: Four hours after intravenous injection (60 mg/m2 body surface) of the photosensitizer dihematoporphyrin ether (DHE), bronchoscopy through his tracheostomy showed continuous oozing of non-clotting blood from bronchial vessels in both lung fields, requiring continuous suction. We performed PDT to seven bronchial sites. The 630 nm wavelength light energy to activate the photosensitizer was generated by a tunable dye argon laser system and delivered to the endobronchus through a quartz fiber modified with a 2.5 cm diffusing tip passed through the biopsy channel of the bronchoscope. The light power was 500 mW per cm of diffuser and the light dose was 200 J per cm of diffuser. At the end of the treatments, the bleeding had decreased so as not to require suctioning. The following day we treated three other sites with the same light dose. At this time the only bleeding was from the LUL, which oozed briskly after passing the bronchoscope through it. At the end of the treatment bronchoscopy there was minimal bleeding.
One week after PDT he was discharged with a tracheosotomy and mechanical ventilator. Four months later his tracheostomy was removed. He remained free of hemoptysis for 26 months when life-threatening hemoptysis recurred. Twenty-two hours after his second injection of DHE, we treated four different endobronchial sites with PDT for bleeding from both the right and left bronchial tree. Sixteen months after his second PDT he remains free of hemoptysis. Three other patients treated for uncontrollable life-threatening hemoptysis for bronchitis have remained free of hemoptysis for 9, 17, and 23 months.
Photodynamic therapy causes thromobosis and can control bleeding from small vessels regardless of their location or etiology.
一名42岁男性，有4年反复进行栓塞治疗、气管切开及依赖呼吸机的病史，因遗传性毛细血管扩张症导致支气管危及生命的咯血，采用光动力疗法（PDT）止血。首次进行光动力治疗时，他在第三次栓塞治疗后10天，通过气管切开进行通气，每天咳出100 - 200毫升血液，需要多次输血和血小板。
研究设计/材料与方法：静脉注射光敏剂双血卟啉醚（DHE）（60毫克/平方米体表面积）4小时后，通过气管切开进行支气管镜检查，发现双肺野支气管血管持续渗出不凝血，需要持续吸引。我们对7个支气管部位进行了光动力治疗。激活光敏剂的630纳米波长光能由可调谐染料氩激光系统产生，通过一根经支气管镜活检通道插入的、带有2.5厘米扩散头的石英纤维传输至支气管内。光功率为每厘米扩散器500毫瓦，光剂量为每厘米扩散器200焦耳。治疗结束时，出血减少，无需吸引。次日，我们用相同的光剂量对另外3个部位进行了治疗。此时，唯一的出血来自左上叶，支气管镜通过该部位后有活跃渗血。治疗结束时支气管镜检查显示出血极少。
光动力治疗1周后，他带着气管切开和机械通气出院。4个月后拔除气管切开管。他在26个月内未再咯血，但随后再次出现危及生命的咯血。第二次注射DHE 22小时后，我们对左右支气管树出血的4个不同支气管内部位进行了光动力治疗。第二次光动力治疗16个月后，他仍未咯血。另外3名因支气管炎导致无法控制的危及生命咯血而接受治疗的患者，分别在9个月、17个月和23个月内未再咯血。
光动力疗法可导致血栓形成，且能控制小血管出血，无论其位置或病因如何。
