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胆管癌(Cholangiocarcinoma CC)是一种罕见的胆道原发性恶性肿瘤,预后较差。根治性手术只适用于一小部分早期诊断的患者。姑息性的经皮或内镜下支架置入胆管引流术能通过减轻瘙痒,疼痛,和胆管炎的程度从而提高生活质量,但对于延长生存时间作用甚微。光动力疗法(PDT)是对于不能手术切除的CC的一种较新颖的局部微创性的姑息疗法。其原理是PDT中使用的光敏性分子能特异性的聚集在增生组织如肿瘤,在特定波长的光照下光敏剂激活生成活性氧类物质,从而选择性的导致肿瘤细胞的死亡。经过初步的可行性性研究和充满前景的前瞻性II期临床研究后,关于研究比较胆管支架置入联合光动力治疗与单纯胆管内支架置入的两组前瞻性随机对照试验已经发表。其中一组试验结果显示PDT组(493天)与非PDT组(98天)相比在中位生存期方面的显著优势(P<0.0001),且PDT组患者的体力状态也明显改善。另一组试验也进一步明确了PDT治疗对于提高生存率方面的优势(PDT组630天而单纯支架置入组210天,P<0.01)。整个治疗过程耐受性良好。有报道称PDT作为CC的辅助或新辅助疗法已取得了令人满意的结果,因此PDT可以被看作是治疗不能手术切除的胆管癌的一种标准性姑息治疗方法。
Cholangiocarcinoma CC is a rare biliary primary malignancy with poor prognosis. Radical surgery is only applicable to a small number of patients with early diagnosis. Palliative percutaneous or endoscopic stent placement of biliary drainage can improve quality of life by reducing the degree of itching, pain, and cholangitis but has little effect on prolonging survival. Photodynamic therapy (PDT) is a relatively new, locally minimally invasive palliative treatment of unresectable CC. The principle is that the photosensitive molecules used in PDT can specifically accumulate in hyperplastic tissues such as tumors, and the photosensitizer activates the production of reactive oxygen species under the light of a specific wavelength, thereby selectively leading to the death of tumor cells. Two prospective randomized controlled trials comparing biliary stent placement with photodynamic therapy and simple biliary stent placement have been published after preliminary feasibility studies and promising prospective phase II clinical studies. One of the trial results showed a significant advantage (P <0.0001) in median survival in the PDT group (493 days) compared with the non-PDT group (98 days) and a significant improvement in physical performance in the PDT group. Another group of trials further clarified the advantages of PDT in improving survival (PDT group 630 days vs stent-only group 210 days, P <0.01). The whole course of treatment is well tolerated. It has been reported that PDT has achieved satisfactory results as an adjuvant or neoadjuvant therapy for CC and therefore PDT can be considered as a standard palliative treatment for unresectable cholangiocarcinoma.