不可切除胆管癌的光动力治疗

胆管癌是起源于胆管上皮细胞的恶性肿瘤,包括肝内胆管癌和肝外胆管癌。根治性切除术是目前治疗胆管癌的首选方法。但由于其发病隐匿,症状出现较晚,早期诊断率较低,往往患者就诊时已为中晚期,失去手术切除的机会,预后极差。据报道,不可切除胆管癌患者的中位生存期仅为3个月。     

光动力治疗在胆管癌中应用研究进展

胆管癌的早期诊断十分困难,大部分病人在初次确诊时已失去手术机会。而未经干预的胆管癌病人,中位生存时间不超过3个月。对于无法接受根治性手术切除的胆管癌病人,合理的胆道引流策略是影响病人生存质量及预后的重要因素。经历过手术建立胆肠旁路引流、胆道支架内引流、经皮肝穿刺胆道外引流等干预措施后,国外已将目光聚集于光动力治疗在胆管癌姑息性治疗中的应用。由于光动力治疗具有治疗创伤性小、术后并发症轻、光敏药物毒副反应少、治疗可重复性强、病灶选择性高等优点,国外已将光动力治疗作为不可切除胆管癌的常用姑息性治疗手段。     

光动力疗法在胆管癌治疗中的应用

由于胆管癌（cholangiocarcinoma）症状出现较晚,大部分病人就诊时已届中晚期,只有一小部分病人适合施行根治性手术,所以胆管癌的预后较差.肿瘤沿胆道系统扩散将导致顽固的梗阻性胆汁郁积、胆管炎和肝衰竭.……     

胆管癌的光动力治疗

胆管癌发病隐匿且恶性程度较高,通常在发现时已达疾病晚期,已丧失根治性手术切除机会。对于晚期胆管癌的姑息性治疗,传统手段常包括胆道支架置入、射频消融术、放化疗等,但胆管癌对放化疗并不敏感。近年来,光动力疗法（PDT）成为了晚期胆管癌患者的另一项选择,作为一种创伤小、不良反应少的治疗方式,逐步应用于晚期胆管癌的姑息性治疗且已取得良好的疗效,引起了学术界的广泛关注。本文从PDT的原理、在胆管癌中的应用及优缺点等方面进行综述。     

胆管癌的光动力治疗

胆管癌是种恶性程度很高的消化道肿瘤,且超过一半的患者在诊断时已是疾病晚期,错失了手术的机会。光动力疗法（PDT）是一种局部消融方法,它使用系统性光敏剂,优先聚集在恶性细胞中,并被非热光激活,通过氧自由基介导的过程导致恶性细胞的破坏。胆管癌的PDT潜在治疗方案包括联合化疗、联合支架植入、复发肿瘤的术后治疗,或对患者进行治疗使肿瘤降期后行根治性手术。在治疗胆汁淤积的同时,PDT疗法可提高生存率和生活质量,并减少肿瘤生长。     

光动力疗法治疗须疮疗效观察

目的：探讨光动力疗法治疗须疮的有效性和安全性。方法：选取笔者医院2016年5月-2020年7月收治的46例须疮患者,采用随机数字表法分为观察组（22例）和对照组（24例）,观察组采用光动力疗法（Photodynamic therapy,PDT）进行治疗,对照组采用盐酸多西环素胶囊+红霉素软膏外涂治疗,对比分析两组治疗效果,不良反应和复发率等情况。结果：观察组治疗后3个月和6个月的有效率分别为95.45%、100.00%,对照组治疗后3个月和6个月的有效率分别为70.83%、75.00%,观察组高于对照组,差异有统计学意义（P<0.05）;两组治疗后积分较治疗前均有所下降,且观察组下降幅度要大于对照组,差异具有统计学意义（P<0.05）。治疗后,观察组不良反应发生率低于对照组,差异具有统计学意义（P<0.05）。观察组治疗后半年复发率为0.00%,1年复发率为4.54%;对照组治疗后半年复发率为16.66%,1年复发率为29.16%。观察组的复发率低于对照组,差异具有统计学意义（P<0.05）。结论：光动力疗法治疗须疮疗效良好,不良反应发生率较低,一年内复发率低于...     

光动力疗法治疗鲜红斑痣的疗效

目的探讨光动力疗法（photodynamic therapy,PDT）治疗鲜红斑痣的临床疗效和安全性。方法采用PDT治疗鲜红斑痣125例。根据患者体重,静脉推注相应的光敏剂PSD-007后,皮损局部行铜蒸气激光照射,至红斑肿胀渗出为治疗结点;每次治疗前采集红斑图像以评价治疗效果。2个月后复诊,采用5级分类法评价前次治疗的效果,并进行患者满意度调查,根据红斑减退变平等情况决定治疗结束或继续下一个疗程治疗。结果PDT治疗鲜红斑痣临床效果明显,治疗后即可出现明显的畸形血管肿胀封闭,经过4个疗程的治疗,治愈率达49．60％,显效率达96．00％,其中经过不到2个疗程的治疗,治愈率即达到13．60％。在整个治疗过程中,患者满意率为95．20％。结论PDT治疗鲜红斑痣疗效显著,美容效果好,不良反应小,值得临床推广应用。     

光动力疗法及其在胆管癌治疗中的应用

胆管癌是起源于胆管上皮细胞的恶性肿瘤,由于其解剖位置特殊,起病隐匿,确诊时往往已到晚期,失去根治性切除机会,预后极差,而胆管癌对放疗和化疗均不敏感,因此,有必要寻找一种新的疗效确切而毒副作用低的治疗方法.光动力疗法(photodynamic therapy,PDT)是一种正在广泛开展中的治疗恶性肿瘤的新技术,国内应用光动力治疗胆管癌处于起步阶段,本文就光动力治疗胆管癌作一综述.     

光动力抑制胆管癌QBC939细胞生长的实验研究

目的研究血卟啉衍生物介导的光动力（HPD-PDT）抑制胆管癌细胞生长状况及其机制。方法 MTT法用于评估人胆管癌细胞（QBC939）的生长状态;Hoechst33258染色和流式细胞术检测细胞凋亡;WesternBlotting法用于探测QBC939细胞中细胞色素C的释放情况;Caspases酶活性测定用于测定caspase-3、-8、-9的活化情况。结果 HPD-PDT在体外能够抑制胆管癌QBC939细胞生长,这一效应主要是通过诱导QBC939细胞线粒体凋亡达到的,在凋亡过程中,出现了细胞色素C释放,caspase-9和-3的活化。结论 HPD-PDT体外能够抑制胆管癌细胞生长,诱导胆管癌细胞凋亡。     

光动力疗法治疗酒渣鼻的疗效

目的观察光动力疗法（photodynamictherapy,PI）T）治疗不同类型酒渣鼻的疗效及其安全性。并与外用10％磺胺醋酰钠、5％硫磺复合霜剂的疗效对比,确定两种治疗方法的优劣。方法酒渣鼻患者43例,随机分为2组,其中23例为PDT组,20例为外用药组。PDT组每7～10d行PDT治疗1次,共治疗3次;外用药组每日用药治疗2次。连续30d。治疗前后拍照片存档,医师根据照片单盲评价症状改薄程度,皮损减轻60％以上视为治疗有效;患者自我记录不良反应,并评价其严承程度;治疗前后要求患者填写皮肤病生活质量指标量表,评价生活质量改善程度。结果PDT组治疗1个月后,总有效牢为65％,其中丘疹脓疱型患者有效率为71％,红斑毛细血管扩张型患者有效,卒为50％;外用药组治疗总有效率为35％。PDT组和外用药组治疗总有效率差异有统计学意义（P％0．05）。PI）T组患者生活质量改善程度优于外用药组;PDT治疗和外用药治疗均没有不可逆性不良反应产生。结论PDT治疗酒渣鼻安全有效,可明显改善患者生活质量,出现的不良反应少且可逆。     

光动力学原理及其在胆管癌治疗的应用

光动力学治疗（photodynamictherapy,PDT）是利用光敏剂在肿瘤组织中的选择性摄取和聚集,并在激发光源的作用下发生光动力学效应产生活性氧簇,进而通过直接氧化杀伤肿瘤细胞;破坏肿瘤微血管,导致血栓形成、肿瘤坏死;激发免疫反应以及诱导肿瘤细胞凋亡等方式杀伤肿瘤组织的治疗方法。PDT作为胆管癌治疗的一种新方法,已经在临床研究及应用过程中得到了肯定。对于不可手术切除的肿瘤患者,无论是PDT单独应用还是与支架置入联合应用,都可以显著延长患者的生存期,有效地改善局部胆道梗阻症状,提高患者生存质量。     

Photodynamic therapy for cholangiocarcinoma

The prognosis of nonresectable cholangiocarcinoma is dismal, and in Bismuth type III and IV tumors relief of jaundice is seldom achieved, despite successful endoprosthesis insertion. Therefore, we evaluated additional photodynamic therapy in patients who failed to respond to endoprostheses insertion. All patients showed good clinical results in regard to jaundice, quality of life; and survival time (median, 439 days). Before initiating a randomized multicenter trial we wanted to evaluate these preliminary results in a greater number of patients. Twenty-one patients underwent photodynamic therapy in addition to endoscopic drainage. The hematoporphyrin derivative Photofrin was infused intravenously (2 mg/kg body weight), and intraluminal photoactivation was performed 2 days later. Bilirubin decreased from a mean level of 201.26 ± 189.25 μmol/l after stenting alone to 68.87 ± 78.27 μmol/l (P = 0.0051), and the Karnofsky index improved from 49.04% ± 28.79% to 72.85 ± 19.01 (P = 0.003). Thirteen patients have died and 8 patients are still alive, with a follow-up period of 82–739 days. The 6-month survival time is 95%. Similar results were obtained by another group, with 75% overall (stage M1 and M0) survival after 6 months and beyond 80% for stage M0. Other authors treated 7 patients and saw a remarkable reduction of bile duct stenosis and bilirubin decrease in all patients. Received: September 5, 2000 / Accepted: October 26, 2000     

血卟啉光动力作用杀伤人胆管癌细胞的实验研究

目的研究血卟啉化衍生物（hematoporphyrin derivative，HPD）光动力作用（photodynamic therapy，PDT）对人胆管癌细胞QBC939的杀伤效应：方法以人胆管癌细胞系QBC939为研究对象，采用血卟啉化合物作为光敏剂，半导体激光治疗仪为光源。实验分为对照组（空白对照组、单纯光动力组、单纯光敏剂组）和光动力作用组，以系列浓度的血卟啉经不同强度光照后，用MTT法测定PDT对QBC939细胞的相对抑制率和筛选最佳PDT参数。结果光动力作用组的吸光度（OD值）与对照组间的差异具有统计学意义（P〈0.01），随着HPD浓度的增加和光照强度的增大，光动力作用对细胞的相对抑制率逐渐增大。不同的光敏剂浓度和光照强度间组合能达到相同的抑制率，如以10mg／L HPD经5J／cm^2光照强度或以4mg／L HPD经15J／cm^2光照强度对QBC939均可以达到92％相对抑制率。在最佳光照能量密度条件下，设计三组功率-时间组合，组间没有显著差异。结论1）PDT对人胆管癌细胞QBC939具有明确的杀伤作用，其对细胞的抑制率具有显著的剂量效应关系。光敏剂浓度和光照强度间存在交互关系，从临床角度考虑，采用较低的光敏剂浓度经较大的光照强度照射是理想的PDT治疗方案。2）改变功率时间的组合不会影响光动力对胆管癌细胞杀伤作用，采用在光纤承受范围内的大功率短时间的照射方式可达到安全快捷的目的。     

High-efficiency light distributior for endoscopic photodynamic therapy

The device used here is a high-efficiency light distributor for endoscopic photodynamic therapy and it has the same area of application as currently used diffusers. However, owing to its emission characteristics and high transmission efficiency it allows one to reduce the irradiation time, for a given laser power, and it favours a hyperthermal contribution to photodynamic therapy.     

Attempt of photodynamic therapy on esophageal varices

Small vessels gradually reappear within the esophageal wall after endoscopic injection sclerotherapy or endoscopic variceal ligation, which causes late recurrent bleeding. Additional ligation or a small amount of sclerotherapy of these thin and serpentine vessels is sometimes difficult to perform, and stenosis of the esophagus sometimes occurs after a small amount of sclerotherapy. In this study we attempted endoscopic photodynamic therapy on newly visible vessels and evaluated its ability to prevent recurrent bleeding. Fourteen patients with newly visible vessels within the esophageal wall were enrolled. All patients had esophageal varices secondary to hepatitis B and had their varices eliminated through endoscopic sclerotherapy before neovascularization. Seven patients received photodynamic therapy, and seven patients served as the control group. In the photodynamic therapy group, intravenous injection of 5 mg/kg of hematoporphyrin monomethyl ether was given and immediately followed by endoscopic irradiation of the newly visible vessels by copper vapor laser for 40 min with a power density of 150 mW/cm². Endoscopic examination was performed 3 months later to evaluate the therapeutic effect. The duration of non-bleeding was compared between the two groups. The number of newly visible vessels was found to have decreased after photodynamic therapy when compared with the control group (P < 0.001). Kaplan–Meier analyses demonstrated a longer period of non-bleeding in the photodynamic therapy group. The recurrent bleeding rate in the photodynamic therapy (PDT) group was lower than that in the control group (P = 0.027). One patient in the photodynamic therapy group suffered from facial dermatitis from shining direct light. Endoscopic photodynamic therapy seemed to be effective in the elimination of esophageal newly visible vessels and the prevention of recurrent bleeding.     

Experimental study of intra-abdominal photodynamic therapy

We have studied experimentally the feasibility of the intra-abdominal application of photodynamic therapy (PDT) by using haematoporphyrin derivative (HPD) and an argon-pumped dye laser. The laser was used to irradiated the para-aortic area of normal and tumour-bearing rats. The results revealed that the walls of large vessels, apart from the endothelium, were left intact in normal rats after the treatment. Endothelial cells in the irradiation region disappeared and regenerated within 5 days of PDT. In the rats with tumours, extensive necrosis of the tumour was observed after PDT, and these treated rats survived significantly longer than the untreated ones (P<0.05). This study suggests that PDT for intra-abdominal tumours is a safe and effective adjuvant to other forms of cancer therapy, and that it does not cause serious damage to major blood vessels or other adjacent normal tissues.     

Cutaneous phototoxicity in photodynamic therapy: Clinical experience with and without histamine antagonists

We have investigated the incidence of cutaneous phototoxicity in 47 patients who received photodynamic therapy between April 1988 and March 1990. Of these, 15 patients received antihistamines as part of a pilot study to evluate their photoprotective role. Patients were followed-up for a minimum of 8 weeks. One out of the fifteen who received antihistamines and 15 out of the 32 patients who did not (p<0.005), developed cutaneous phototoxicity. On the basis of these results we have initiated a randomized double-blind trial to evaluate the role of antihistamines in haematoporphyrin derivative-induced cutaneous phototoxicity.     

A method for the construction of disposable cylindrical diffusing fibre optic tips for use in photodynamic therapy

A simple method for the manufacture of disposable, cylindrical, diffusing fibre tips is described. The method is suitable for plastic clad silica fibres with core diameters in the range 200–600m. Light diffusing tips up to 40 mm in length have been constructed. The method is highly reproducible, construction is typically less than five minutes and the financial cost is negligible. The diffusers are highly efficient, delivering an amount of light at least equal to that transmitted by a plane cut fibre of the same core diameter. The uniformity of light emission along the diffuser can be modified to meet the requirements of any given treatment. The diffusers have been successfully used in interstitial photodynamic therapy.