经皮经胆道镜激光消融术与光动力疗法治疗胆管黏液性囊性肿瘤的临床疗效及治疗技巧

Percutaneous transhepatic choledochoscopic laser ablation combined with photodynamic therapy for mucinous cystic neoplasm of bile duct

摘要:

目的 探讨经皮经胆道镜激光消融术与光动力疗法（PDT）治疗胆管黏液性囊性肿瘤的临床疗效及治疗技巧。方法 回顾性分析2018年1月－2023年12月该院消化内科收治的13例胆管黏液性囊性肿瘤患者的临床资料，采取经皮经胆道镜激光消融术、PDT治疗或两者联合治疗。观察患者手术相关情况、病灶情况、引流情况、术后6个月生存情况和并发症发生情况。结果 所有患者均顺利完成经皮经胆道镜激光消融、PDT或两者联合治疗，治疗成功率为100%。所有患者术后体温恢复正常。7例患者术后1周内黄疸明显减退，其余6例黄疸虽然未明显减退，但血清总胆红素有所下降或保持稳定。所有患者术后1周内，胆管各分支新生物减少，病灶明显缩小。术后早期（30 d内），所有患者引流管均保持通畅，未发生因肿瘤组织脱落或坏死物堵塞所导致的急性堵管事件。术后引流管留置时间平均为4.2个月。术后6个月，无死亡病例，术后6个月生存率为100%。未发生胆道穿孔和大出血等严重并发症。结论 经皮经胆道镜激光消融术联合PDT治疗胆管黏液性囊性肿瘤，可以缩小病灶范围，缓解胆道梗阻，提高患者生活质量，且并发症少。值得临床推广应用。

Abstract:

Objective To evaluate the clinical efficacy and technical aspects of percutaneous transhepatic choledochoscopic laser ablation and photodynamic therapy (PDT) in the treatment of mucinous cystic neoplasm of bile duct.Methods A retrospective analysis was conducted on 13 patients with mucinous cystic neoplasms of the bile duct treated between January 2018 and December 2023. All patients underwent treatment with percutaneous transhepatic choledochoscopic laser ablation, PDT, or a combination of both. Observe the surgery-related conditions of the patients, the lesion conditions, the drainage conditions, the survival status 6 months after the operation and the occurrence of complications.Results All patients successfully completed percutaneous transhepatic choledochoscopic laser ablation, PDT or a combination of both, with a treatment success rate of 100%. The body temperature of all patients returned to normal after the operation. Jaundice decreased in 7 patients within one week after the operation. In the remaining 6 patients, although jaundice did not decrease significantly, the total serum bilirubin decreased or remained stable. Within one week after the operation, the neoplasms in each branch of the bile duct of all patients decreased, and the lesions shrank significantly. In the early postoperative period (within 30 days), the drainage tubes of all patients remained unobstructed, and no acute tube blockage events caused by tumor tissue shedding or necrotic substances occurred. The average indwelling time of the drainage tube after the operation was 4.2 months. Six months after the operation, there were no deaths and the 6-month survival rate was 100%. No serious complications such as biliary perforation and massive hemorrhage occurred.Conclusion Percutaneous choledochoscopic laser ablation combined with PDT for the treatment of mucinous cystic tumors of the bile duct can reduce the lesion range, relieve biliary obstruction, improve the quality of life of patients, and has few complications. It is worthy of clinical promotion and application.