目的

探讨ERCP 联合SpyGlass 内镜下射频消融（RFA）+光动力疗法（PDT）+胆道支架置入（BS）综合治疗在晚期胆管癌中的应用价值。

方法

回顾性分析2023 年 6 月兰州大学第二医院收治的1 例胆管癌患者临床资料。患者女，61 岁，主因“进食后上腹胀痛1 月”于2023 年6 月13 日收入院。查体：皮肤黏膜及巩膜轻度黄染，中上腹及脐周可触及包块，质硬，可活动；左锁骨上肿物，约2 cm×1 cm，无红肿、疼痛、破溃。肿瘤标记物：CA19-9＞1 000 kU/L，CEA 251 μg/L，CA72-4 32.8 kU/L。CT 示胆总管上段管壁稍增厚并明显强化，MRCP 示肝总管与胆总管交界处胆管管壁环形增厚呈软组织影，考虑胆管癌。初步诊断胆管癌并颈部淋巴结转移。

结果

积极术前准备后行ERCP 内镜SpyGlass下黏膜活检，示胆管印戒细胞癌。内镜下置入1 胆道金属裸支架（0.6 cm×1.0 cm），联合RFA 及PDT综合治疗，PDT 治疗1 次/d，共治疗3 d。术后辅助白蛋白紫杉醇+卡培他滨系统治疗。经治疗后肝功能指标明显好转，CEA 经治疗后复查降为169 μg/L。复查MRCP 示肝总管与胆总管交界处胆管管壁环形增厚程度较前减轻，相应管腔狭窄程度及肝内胆管扩张程度较前减轻。

结论

ERCP 下BS 联合RFA及PDT 为晚期胆管癌患者的内镜综合治疗提供了新的思路，使更多晚期胆管癌患者获益。

Objective

To evaluate the application value of ERCP combined with SpyGlass endoscopic radiofrequency ablation （RFA）+ photodynamic therapy （PDT）+ biliary stenting （BS） in advanced cholangiocarcinoma.

Methods

Clinical data of 1 patient with cholangiocarcinoma admitted to the Second Hospital of Lanzhou University in June 2023 were analyzed retrospectively.On June 13，2023， the 61-year-old female patient was admitted to the hospital due to “abdominal pain after eating for 1 month”.Physical examination： the skin mucosa and sclera were slightly yellow， and a firm and movable mass was palpable in the middle and upper abdomen and around the umbilicus.The left supraclavicular mass was approximately 2 cm×1 cm， without redness， swelling， pain and ulceration.Tumor markers：CA19-9＞1 000 kU/L， CEA 251 μg/L and CA72-4 32.8 kU/L.CT scan showed that the wall of the upper segment of common bile duct was slightly thickened and significantly enhanced.MRCP revealed that the circular thickening of the wall of common bile duct at the junction of the common hepatic duct and common bile duct， manifested as soft tissue shadow， which was considered as cholangiocarcinoma.Preliminary diagnosis of cholangiocarcinoma complicated with cervical lymph node metastasis was made.

Results

After comprehensive preoperative preparation， ERCP combined with SpyGlass endoscopic mucosal biopsy revealed signet ring cell carcinoma of the bile duct.A bare metal biliary stent （0.6 cm×1.0 cm） was implanted under endoscope combined with RFA and PDT.PDT was given once a day for 3 d.Postoperative adjuvant systemic therapy of albumin paclitaxel+capecitabine was delivered.After corresponding treatment， liver function indexes were significantly improved.CEA level was significantly declined from 251 μg/L to 169 μg/L.Repeated MRCP showed that the annular thickening of bile duct wall at the junction of the common bile duct and common bile duct was mitigated， and corresponding lumen stenosis and intrahepatic bile duct dilatation were also alleviated.

Conclusions

BS combined with RFA and PDT under ERCP provides a novel idea for comprehensive endoscopic treatment for patients with advanced cholangiocarcinoma， which will bring more benefits.