食管/贲门癌内镜下光动力治疗光照时机选择的临床研究

目的探讨激光照射时机的选择对食管／贲门癌光动力治疗（photodynamic therapy，PDT）的近期疗效及毒副反应的影响。方法40例中、晚期食管／贲门癌按就诊先后随机分为A、B二组。A组选择光敏剂（Photofrin）静脉滴注后24和48h经内镜导入光导纤维，给以630nm（Diomed半导体激光治疗机）的激光照射750s；B组选48和72h照射，之后对比观察。结果光动力治疗后二组有效率分别为85％和75％。但差异无显著性（P〉0．05）；食管梗阻改善有效率分别为90％和60％，差异具有显著性（P〈0．05）；二组的毒副反应分别为40．2％和15．8％，差异具有显著性（P〈0．01）。结论光动力能够明显改善中、晚期食管／贲门癌患者的生存质量，是一种不可缺少的治疗手段，但是一定要选择合适的治疗时机。

Clinical study of time optimizing of endoscopic photodynamic therapy on esophageal and/or gastric cardiac cancer

[Objective] To evaluate the clinical efficacy and adverse effects of Photodynamic Therapy (PDT) on esophageal and/or gastric cardiac cancer during time optimizing for employing laser irradiation. [Methods] 40 patients with advanced esophageal and/or gastric cardiac cancer were divided into group A and group B ad lib. Following intravenous administration of photofrin at dose of 2 mg/kg.b.w. as the photosensitizer, 630nm laser irradiation (DIOMED) with 400 mW/cm was applied on each part of tumor for 750 seconds through cylinder diffusing quartz fibers localizing in the biopsy channel of a flexible endoscope at 24th and 48th for group A and at 48th and 72nd for group B respectively. [Results] The total rates (CR+PR) of effective were 85% and 75% respectively in two groups after PDT with P >0.05; the relief rates of lumen obstruction were 90% and 60% respectively with statistical significance (P <0.05); the frequency of adverse effects were 44.2% and 15.8% respectively with P <0.01. [Conclusions] The therapy of photofrin PDT was effective in improving life quality of patients with advanced esophageal and/or gastric cardiac cancer and the time optimizing for employing laser irradiation was of great importance.