内镜下光动力治疗在不可切除肝门部胆管癌梗阻性黄疸治疗中的作用研究

Clinical efficacy of endoscopic photodynamic therapy combined with stent placement for obstructive jaundice in unresectable hilar cholangiocarcinoma

摘要:

目的 探讨内镜下光动力治疗（photodynamic therapy， PDT）联合胆管支架置入在不可切除肝门部胆管癌梗阻性黄疸中的临床疗效。方法 回顾性分析2020年1月至2023年1月中科大附一院（40例）和铜陵市人民医院（3例）收治的共43例不可切除肝门部胆管癌发生梗阻性黄疸的患者临床资料，支架组（n=23）单纯置入胆管支架，联合组（n=20）行PDT联合胆管支架置入。对比两组患者的胆红素下降程度、支架通畅期、术后卡氏行为评分、并发症发生情况及预后情况。采用Cox回归分析患者生存期的影响因素。结果 支架组和联合组一般资料比较差异无统计学意义（P>0.05）。术后联合组的支架通畅时间为204.53 d（95%CI：143.75~265.32 d），长于支架组的138.36 d（95%CI：95.38~181.34 d），差异无统计学意义（P=0.091）。支架组和联合组术后1周中位胆红素下降值分别为30.10 μmol/L和9.40 μmol/L，差异无统计学意义（Z=-0.243，P=0.808）。支架组和联合组术后1个月［（69.09±12.69）分和（73.16±13.36）分，t=-0.999，P=0.324］和3个月卡氏行为评分［（67.14±9.94）分和（70.67±10.33）分，t=-0.935，P=0.358］差异无统计学意义。联合组的总体生存期为267.38 d（95%CI：186.93~347.83 d），显著长于支架组的140.41 d（95%CI：97.38~183.45 d）（P=0.017）。Cox回归多因素分析显示，PDT联合胆管支架置入（HR=0.457，95%CI：0.212~0.986，P=0.046）是患者生存期的独立保护因素。结论 内镜下PDT联合胆管支架置入可有效缓解不可切除肝门部胆管癌的梗阻性黄疸，改善患者的生活质量，延长患者的生存时间。

Abstract:

Objective To investigate the clinical efficacy of endoscopic photodynamic therapy (PDT) combined with biliary stent placement for obstructive jaundice in unresectable hilar cholangiocarcinoma. Methods Clinical data of a total of 43 patients with obstructive jaundice in unresectable hilar cholangiocarcinoma admitted to the First Affiliated Hospital of University of Science and Technology of China (40 cases) and Tongling Municipal Hospital (3 cases) from January 2020 to January 2023 were retrospectively analyzed. Patients were divided into the stent group (n=23, endoscopic biliary stent placement) and the combination group (n=20, endoscopic PDT combined with biliary stent placement). The bilirubin decline, stent patency time, postoperative Karnofsky performance score (KPS), complications and prognosis data of the two groups were compared. Cox regression multivariate analysis was used to explore the influencing factors for survival of the patients. Results There was no significant difference in general data between the two groups (P>0.05). The stent patency time in the combination group was 204.53 days (95%CI: 143.75-265.32 days), which was longer than that in the stent group (138.36 days, 95%CI: 95.38-181.34 days), with no significant difference (P=0.091). Median bilirubin decreases in the stent group and the combination group were 30.10 μmol/L and 9.40 μmol/L, respectively, with no significant difference (Z=-0.243, P=0.808) at 1 week after surgery. There was no significant difference in KPS at 1 month (69.09±12.69 VS 73.16±13.36, t=-0.999, P=0.324) and 3 months after the surgery (67.14±9.94 VS 70.67±10.33, t=-0.935, P=0.358) in the stent group and the combination group. The overall survival time of the combination group was 267.38 days (95%CI: 186.93‑347.83 days), significantly longer than that of the stent group (140.41 days, 95%CI: 97.38‑183.45 days) (P=0.017). The Cox regression multivariate analysis showed that endoscopic PDT combined with biliary stent placement was an independent protective factor for survival (HR=0.457, 95%CI:0.212‑0.986, P=0.046). Conclusion Endoscopic PDT combined with biliary stent placement could effectively relieve obstructive jaundice, improve quality of life and ultimately prolong the survival time of unresectable hilar cholangiocarcinoma patients.