Ortner M A, Liebetruth J, Schreiber S, Hanft M, Wruck U, Fusco V, Müller J M, Hörtnagl H, Lochs H
Fourth Medical Department, Medical Faculty Charité, Humboldt University, Berlin, Germany.
Gastroenterology. 1998 Mar;114(3):536-42. doi: 10.1016/s0016-5085(98)70537-2.
BACKGROUND & AIMS: Successful treatment in nonresectable Bismuth type III and IV cholangiocarcinoma is seldom achieved. The aim of this study was to evaluate the effect of photodynamic therapy on cholestasis, quality of life, and survival in these patients.
Nine patients with advanced nonresectable cholangiocarcinomas Bismuth type III and IV, who showed no sufficient drainage (bilirubin decrease <50%) after endoscopic stent insertion, underwent photodynamic therapy. Two days after intravenous application of a hematoporphyrin derivate, intraluminal photoactivation was performed cholangioscopically. Serum bilirubin, quality of life, and survival time were assessed in two monthly intervals after photodynamic therapy.
After photodynamic therapy, bilirubin serum levels declined from 318 +/- 72 to 103 +/- 35 micromol/L (P = 0.0039) with no significant increase during the two monthly follow-ups. Quality of life indices improved dramatically and remained stable (e.g., Karnofsky index from 32.2% +/- 8.13% to 68.9% +/- 6.1%; P = 0.0078). Thirty-day mortality was 0%, and median survival time was 439 days.
This study provides clear evidence that photodynamic therapy is effective in restoring biliary drainage and improving quality of life in patients with nonresectable disseminated cholangiocarcinomas Bismuth type III and IV. Compared with published data, survival time seems to be prolonged.
不可切除的Bismuth III型和IV型胆管癌很少能成功治疗。本研究的目的是评估光动力疗法对这些患者胆汁淤积、生活质量和生存的影响。
9例晚期不可切除的Bismuth III型和IV型胆管癌患者，在内镜下置入支架后胆汁引流不充分（胆红素下降<50%），接受了光动力疗法。静脉注射血卟啉衍生物2天后，通过胆管镜进行腔内光激活。光动力治疗后每两个月评估血清胆红素、生活质量和生存时间。
光动力治疗后，血清胆红素水平从318±72降至103±35μmol/L（P = 0.0039），在两个月的随访期间无显著升高。生活质量指标显著改善并保持稳定（如卡诺夫斯基指数从32.2%±8.13%升至68.9%±6.1%；P = 0.0078）。30天死亡率为0%，中位生存时间为439天。
本研究提供了明确的证据，表明光动力疗法在恢复不可切除的播散性Bismuth III型和IV型胆管癌患者的胆汁引流和改善生活质量方面是有效的。与已发表的数据相比，生存时间似乎延长了。
