内镜下光动力疗法治疗壶腹部肿瘤的临床疗效

Clinical effect of endoscopic photodynamic therapy on patients with ampullary tumor

摘要:

目的 探讨内镜下光动力疗法（PDT）治疗壶腹部肿瘤的临床疗效。方法 回顾性分析2019年2月－2020年12月山东省立第三医院收治的14例壶腹部肿瘤患者的临床资料。术前48 h给予静脉输注血卟啉注射液，首次实施内镜下PDT治疗，术后24 h再行1次PDT照射，评估技术操作成功率及并发症发生情况，术后2个月复查内镜评估临床疗效。结果 14例患者均成功完成内镜下PDT治疗，技术成功率100%。所有病例均未发生穿孔和出血；1例术后出现轻型急性胰腺炎，经放置胰管支架并抑酶、补液等治疗后痊愈；1例术后并发轻症胆管炎，经抗感染治疗后恢复；无胆管狭窄及迟发性胆管炎发生。术后2个月内镜复查见十二指肠乳头肿瘤组织坏死脱落，表面光整，内镜下于乳头处再次取活检，病理结果证实：十二指肠乳头黏膜慢性炎10例，十二指肠乳头腺癌4例。其中，4例腺癌患者进行了第2次PDT治疗。结论 内镜下PDT治疗壶腹部肿瘤是安全和有效的，其远期疗效有待大样本、多中心的临床研究来证实。

Abstract:

Objective To explore the clinical efficacy of endoscopic photodynamic therapy (PDT) in ampullary tumor.Methods The clinical data of 14 patients with ampullary tumor were collected from February 2019 to December 2020 were retrospectively analyzed. Hematoporphyrin was injected intravenously 48 h before surgery, the first endoscopic PDT was performed, and the second PDT irradiation was performed 24 h after the operation. Then we evaluate the success rate and complications of the PDT, and the clinical efficacy was also evaluated with endoscopy 2 months after surgery.Results Endoscopic PDT treatments were all successfully completed in 14 patients with a technical success rate of 100%. No perforation or bleeding complications occurred. One case of mild acute pancreatitis occurred after operation, but recovered quickly after placing a pancreatic duct stent and treating with enzyme inhibition and infusion. One case of mild cholangitis occurred after operation, which recovered after anti-infective treatment. No bile duct stricture and delayed cholangitis occurred. The duodenal papilla tumor tissue necrosis and fall off, and the surface was smooth two months after the PDT. Pathological results confirmed 10 cases of chronic inflammation of the duodenal papilla mucosa, 4 cases of duodenal papillary adenocarcinoma while they all received the second PDT treatment.Conclusion Endoscopic PDT for ampullary tumor is safe and effective, while it needs a large sample, multi-center clinical research to confirm its long-term efficacy.