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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (04) : 595 -600. doi: 10.3877/cma.j.issn.2095-3232.2025.04.015

临床研究

内镜下光动力疗法联合胆道支架治疗不可切除胆管癌的疗效
高彬1,2, 宋铭杰2, 宁江红2, 邵英梅2,†()   
  1. 1830001　乌鲁木齐，新疆维吾尔自治区人民医院医美中心（高彬原为新疆医科大学第一附属医院研究生）
    2830054　乌鲁木齐，新疆医科大学第一附属医院消化血管外科中心肝胆包虫病外科
  • 收稿日期:2025-01-02 出版日期:2025-08-10
  • 通信作者: 邵英梅
  • 基金资助:
    省部共建中亚高发病成因与防治国家重点实验室开放课题重点项目(SKL-HIDCA-2023-2)

Efficacy of endoscopic photodynamic therapy combined with biliary stenting in the treatment of unresectable cholangiocarcinoma

Bin Gao1,2, Mingjie Song2, Jianghong Ning2, Yingmei Shao2,†()   

  1. 1Medical Aesthetics Center, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
    2Department of Hepatobiliary Hydatid Surgery, Digestive Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2025-01-02 Published:2025-08-10
  • Corresponding author: Yingmei Shao
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高彬, 宋铭杰, 宁江红, 邵英梅. 内镜下光动力疗法联合胆道支架治疗不可切除胆管癌的疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 595-600.

Bin Gao, Mingjie Song, Jianghong Ning, Yingmei Shao. Efficacy of endoscopic photodynamic therapy combined with biliary stenting in the treatment of unresectable cholangiocarcinoma[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(04): 595-600.

目的

探讨内镜下光动力疗法（PDT）联合胆道支架治疗不可切除胆管癌的疗效。

方法

回顾性分析2019年1月至2021年12月新疆医科大学第一附属医院收治的21例不可切除胆管癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男12例，女9例；年龄53~ 87岁，中位年龄74岁；肝门部胆管癌Bismuth分型Ⅰ~Ⅱ型4例，胆总管中下段癌17例。根据治疗方式不同分为PDT+支架组（7例）和单纯支架组（14例）。两组手术时间、总住院时间、支架通畅时间等比较采用秩和检验。术后并发症发生率比较采用Fisher确切概率法，生存分析采用Kaplan-Meier法和Log-rank检验。

结果

PDT+支架组手术时间、总住院时间、支架通畅时间分别为98（64，120）min、15（10，17）d、8（4，10）个月，明显长于单纯支架组的30（23，49）min、6（5，8）d、4（3，6）个月（Z=3.331，3.122，2.298；P<0.05）。PDT+支架组总住院费用（6.3±0.9）万元，亦明显高于单纯支架组的（3.5±0.8）万元（t=7.796，P<0.001）。PDT+支架组术后腹痛2例、急性胰腺炎1例、胆道感染2例、光过敏反应1例，单纯支架组术后腹痛3例、急性胰腺炎4例、胆道感染2例，两组术后并发症发生率比较差异无统计学意义（P>0.999）。PDT+支架组和单纯支架组中位生存时间分别为10.1、5.2个月，PDT+支架组总体生存明显优于单纯支架组（χ2=10.95，P<0.001）。

结论

PDT联合胆道支架治疗相较单纯支架治疗不可切除胆管癌患者，可明显延长支架通畅时间以及术后生存时间，且不增加术后并发症发生率。

关键词: 胆管癌, 肝外胆管癌, 肝门部胆管癌, 光动力, 胆道支架
Objective

To investigate the efficacy of endoscopic photodynamic therapy (PDT) combined with biliary stenting in the treatment of unresectable cholangiocarcinoma.

Methods

Clinical data of 21 patients with unresectable cholangiocarcinoma admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2019 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 9 female, aged from 53 to 87 years, with a median age of 74 years. Four cases were diagnosed with Bismuth type Ⅰ-Ⅱ hilar cholangiocarcinoma and 17 cases of the middle and lower common bile duct carcinoma. According to different treatments, all patients were divided into PDT + stenting group (n=7) and single stenting group (n=14). The operation time, total length of hospital stay and stent patency time between two groups were compared by rank-sum test. The incidence of postoperative complications was compared by Fisher’s exact test. Survival test was conducted by Kaplan-Meier method and Log-rank test.

Results

The operation time, total length of hospital stay and stent patency time in PDT + stenting group were 98 (64,120) min, 15 (10,17) d and 8 (4,10) months, significantly longer than 30 (23,49) min, 6 (5,8) d and 4 (3,6) months in the single stenting group (Z=3.331, 3.122, 2.298; all P<0.05). The total hospitalization expense in the PDT + stenting group was (6.3±0.9) ×104 Yuan, significantly higher than (3.5±0.8) ×104 Yuan in the single stenting group (t=7.796, P<0.001). In the PDT + stenting group, 2 cases were diagnosed with postoperative abdominal pain, 1 case of acute pancreatitis, 2 cases of biliary tract infection and 1 case of photosensitive reaction. In the single stenting group, 3 cases experienced postoperative abdominal pain, 4 cases of acute pancreatitis and 2 cases of biliary tract infection. The difference in the incidence of postoperative complications was not statistically significant between two groups (P>0.999). In the PDT + stenting and single stenting groups, the median survival time was 10.1 and 5.2 months. The overall survival in the PDT + stenting group was significantly better than that in the single stenting group (χ2=10.95, P<0.001).

Conclusions

Compared with single stenting, PDT combined with biliary stenting can significantly prolong stent patency time and postoperative survival time without increasing the incidence of postoperative complications in patients with unresectable cholangiocarcinoma.

Key words: Cholangiocarcinoma, Extrahepatic bile duct cancer, Hilar cholangiocarcinoma, Photodynamic, Biliary stent
表1 两组不可切除胆管癌患者一般资料比较
指标 PDT+支架组 单纯支架组 统计值 P值
男性(例) 6 6 - 0.159
年龄(岁,±s) 73±7 73±10 t=-0.017 0.987
BMI(kg/m2,±s) 21.3±1.5 22.4±1.5 t=-1.644 0.117
高血压(例) 5 9 - 0.624
糖尿病(例) 2 2 - 0.574
呼吸系统疾病(例) 1 1 - 1.000
心脑血管疾病(例) 1 2 - 1.000
胆囊结石病史(例) 5 12 - 0.574
胆管结石病史(例) 1 7 - 0.174
Bismuth-Corlette分型Ⅰ型(例) 6 10 - 0.624
胆道狭窄长度(cm,±s) 2.1±0.9 2.8±1.0 t=-1.635 0.119
淋巴结转移(例) 3 4 - 0.638
TB[μmol/L,M(Q1,Q3)] 44(27,2 109) 177(84,273) Z=-0.970 0.332
GGT[U/L,M(Q1,Q3)] 259(114,414) 590(320,898) Z=-1.865 0.062
ALP[U/L,M(Q1,Q3)] 207(137,149) 435(291,579) Z=-1.641 0.101
表2 两组不可切除胆管癌患者围手术期情况比较
组别 例数 手术时间[min,M(Q1,Q3)] 术后住院时间[d,M(Q1,Q3)] 总住院时间[d,M(Q1,Q3)] 总住院费用(万元,±s) 支架通畅时间[月,M(Q1,Q3)]
PDT+支架组 7 98(64,120) 3(2,6) 15(10,17) 6.3±0.9 8(4,10)
单纯支架组 14 30(23,49) 4(2,5) 6(5,8) 3.5±0.8 4(3,6)
统计值   Z=3.331 Z=-0.076 Z=3.122 t=7.796 Z=2.298
P值   <0.001 0.957 <0.001 <0.001 0.019
表3 两组不可切除胆管癌患者术后并发症比较（例）
组别 例数 腹痛 急性胰腺炎 胆道感染 光过敏反应 并发症总数
PDT+支架组 7 2 1 2 1 6
单纯支架组 14 3 4 2 0 8
P值a   >0.999 0.624 0.574 0.364 >0.999
图1 两组不可切除胆管癌患者Kaplan-Meier生存曲线注：PDT为光动力疗法
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