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

doi:10.3877/cma.j.issn.2095-3232.2025.04.015

Abstract

Abstract:

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

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

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References 20

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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

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

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

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

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

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