摘要
目的探讨内镜下光动力治疗(photodynamic therapy,PDT)联合支架置入治疗胆管癌及壶腹癌的临床疗效。方法回顾性分析2013年9月—2016年12月东方肝胆外科医院收治的60例胆管癌及壶腹癌患者资料,支架组(n=36)单纯置入胆道支架,PDT组(n=24)行PDT联合胆道支架置入。记录临床资料及随访情况,统计分析2组临床成功率、并发症发生率、支架通畅期及生存期。结果支架组和PDT组基线资料比较差异无统计学意义(P均>0.05)。2组临床成功率[94.4%(34/36)比95.8%(23/24),χ^2=0.060,P=1.000]及术后并发症发生率比较[41.7%(15/36)比62.5%(15/24),χ^2=2.50,P=0.187]差异无统计学意义。PDT组术后第1、3、6个月Karnofsky行为评分均较支架组高(P均<0.001)。支架组与PDT组支架中位通畅期分别为102.0 d(95%CI:73.9~130.1 d)与119.0 d(95%CI:96.8~141.2 d)(P=0.634),中位生存期分别为162.0 d(95%CI:125.0~199.0 d)与327.0 d(95%CI:215.9~438.1 d)(P=0.006)。Cox回归多因素分析显示,PDT是患者生存时间的保护因素(P=0.012),而胆总管癌(P=0.016)与更高TNM分期(P=0.001)是患者生存时间的危险因素。结论内镜下PDT联合支架置入可有效延长胆管癌及壶腹癌患者的生存时间。PDT、病变部位与TNM分期是影响生存时间的独立预后因子。
Objective To evaluate the efficacy of endoscopic photodynamic therapy(PDT)combined with biliary stenting on treatment of patients with extrahepatic cholangiocarcinoma or ampullary carcinoma.Methods Data of 60 patients with extrahepatic cholangiocarcinoma or ampullary carcinoma were collected in Eastern Hepatobiliary Hospital from September 2013 to December 2016,and patients were divided into stent group(n=36,undergone endoscopic biliary stenting only)and PDT group(n=24,undergone endoscopic PDT combined with biliary stenting).The clinical success rate,adverse events incidence,stent patency time and overall survival time were analyzed.Results No significant differences were found on baseline data between the stent group and PDT group(all P>0.05).No significant difference was found between the two groups in clinical success rate[94.4%(34/36)VS 95.8%(23/24),χ^2=0.060,P=1.000],and early adverse events incidence[41.7%(15/36)VS 62.5%(15/24),χ^2=2.50,P=0.187].The Karnofsky performance score of the first,third and sixth month after operation in the PDT group were significantly higher than those in the stent group(all P<0.001).The median patency time of stent was 102.0 d(95%CI:73.9-130.1 d)in the stent group,and 119.0 d(95%CI:96.8-141.2 d)in the PDT group(P=0.634).However,the median overall survival time was longer in the PDT group(327.0 d,95%CI:215.9-438.1 d)than that in the stent group(162.0 d,95%CI:125.0-199.0 d,P=0.006).Cox regression analysis showed that PDT was associated with a longer survival(P=0.012),while distal cholangiocarcinoma(P=0.016)and higher TNM staging(P=0.001)were associated with a shorter survival.Conclusion PDT with biliary stenting results in a longer survival and a better quality of life than the stenting therapy alone in patients with extrahepatic cholangiocarcinoma or ampullary carcinoma.PDT,location of lesions and TNM staging are independent prognostic factors for the survival of patients.
作者
高道键
叶馨
吴军
王田田
夏明星
胡冰
Gao Daojian;Ye Xin;Wu Jun;Wang Tiantian;Xia Mingxing;Hu Bing(Department of Endoscopy,Eastern Hepatobiliary Hospital,The Naval Military Medical University,Shanghai 200438,China)
出处
《中华消化内镜杂志》
CSCD
北大核心
2020年第9期621-627,共7页
Chinese Journal of Digestive Endoscopy
基金
海军军医大学第三附属医院孟超人才计划-优秀中青年医师英才开发计划。
关键词
胰胆管造影术
内窥镜逆行
光动力治疗
胆管癌
壶腹癌
Cholangiopancreatography,endoscopic retrograde
Photodynamic therapy
Cholangiocarcinoma
Ampullary carcinoma
