首页 / 新闻 / 沈阳市级医院首例胆管癌内镜下ERCP联合光动力(PDT)治疗在沈阳六院成功开展

沈阳市级医院首例胆管癌内镜下ERCP联合光动力(PDT)治疗在沈阳六院成功开展

细长的光纤搭载着激光,肿瘤细胞“见光脱落坏死”!近日,沈阳市第六人民医院消化内镜科潘良宇主任团队成功完成内镜下ERCP联合光动力(PDT)治疗胆管癌患者一例,此手术为沈阳市市级医院首例。

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买菜做饭带孙子……77岁的周大姨一直是个忙里忙外的勤快人儿。可是今年5月开始,周阿姨觉得浑身无力,食欲不振;儿女们还发现,周大姨皮肤、巩膜黄染。6月中旬,一家人来到沈阳六院中西医结合肝病科就诊,入院后经过化验及相关影像学检查,周大姨被诊断为胆管占位不除外,梗阻性黄疸。

周大姨年纪偏大,外科手术风险高,市六院旋即启动MDT多学科专家会诊。家属听从医生建议,同意内镜微创手术进行胆汁内引流。6月28日,消化内镜科潘良宇主任为周大姨成功实施了ERCP(经内镜逆行性胰胆管造影术)+胆管上皮细胞肿瘤活检+胆胰管双支架置入引流术,术后周大姨的黄疸得到了明显改善(从术前的230mg/dL下降到27mg/dL),但是细胞活检结果证实为“(胆管)上皮源性恶性肿瘤”

接下来如何治疗恶性肿瘤,就成了难题。对于周大姨这样的高龄患者来说,传统治疗手段的手术创伤大,风险高,疗效也很差,复发率高,根治性切除率低,且对化疗和放疗亦不敏感。以往面对这样的患者,多数是通过介入穿刺行外引流术或胆道支架植入,对患者创伤大,术后生活不便;而之前进行的内镜微创ERCP行支架内引流术也仅能改善梗阻症状,并没有对肿瘤本身进行治疗。

    胆汁引流术后,周大姨就在消化内镜科病房休养。尽管家属一直隐瞒着真实的诊断结果,但是躺在病床上的周大姨仍然像是知道了什么,总和孩子们念叨“别给妈治了,妈不想再遭罪,我一个老太太也得给你们省点钱啊!”每每至此,周大姨的一双儿女都强忍眼泪,心如刀绞。

怎样才能帮助周大姨驱走胆管癌这个恶魔呢?沈阳市第六人民医院消化内镜科仔细研判病情,结合患者目前的实际情况,暂未发现肿瘤有远处转移,在与患者家属充分沟通后,最终敲定了光动力手术的治疗方案。

光动力治疗作为一种新兴的微创、精准的肿瘤局部治疗方法,用特定波长照射肿瘤部位,能使选择性聚集在肿瘤组织的光敏药物活化,引发光化学反应破坏肿瘤组织;同时具有手术耗时短,病人痛苦小,恢复快,并发症少,无耐药性等优势。

8月5日,沈阳市第六人民医院消化内镜科潘良宇主任为周大姨进行了内镜下ERCP介导下光动力手术治疗。整个手术过程非常顺利,光动力治疗仅耗时20分钟,术后患者并无明显发热、腹痛及胆管炎等并发症。

术后一周,周大姨身上的黄染褪去,食欲逐渐恢复,精神头足了,也不再念叨那些不吉利的话儿了,顺利出院。

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光动力技术的成功引进,为癌症患者打开了一扇希望之窗。沈阳市第六人民医院消化内镜科一直致力于研究中晚期消化道恶性肿瘤新的治疗方法,提高患者的生存质量,延长患者的生存时间。沈阳六院消化内镜科潘良宇主任表示,未来,除了应用光动力疗法继续造福胆管癌患者之外。在一些现有技术手段受限的恶性消化道肿瘤治疗领域,如术后吻合口复发的胃癌、放化疗失败的消化道癌症、以及需要保肛的直肠癌等等,将会继续开展光动力治疗,进一步提高消化道及肝胆胰肿瘤的综合诊疗水平,为更多的癌症患者解除病痛,带来福音。

科普:

1、到底什么是光动力疗法?

光动力疗法是一种全新的治疗方式,注射光敏剂后,利用激光照射治疗恶性肿瘤的新技术。具有高选择性,副作用小,疗效确切,无耐药性,可重复治疗,以及保护器官功能等优点,是一种新型的靶向治疗技术。国外开展较早,国内近几年才陆续开展此项技术,多项研究表明,通过PDT治疗,胆管肿瘤患者的生存时间显著延长。

2、光动力是如何杀死肿瘤细胞的呢?

光动力治疗是利用注射的光敏剂选择性聚集在肿瘤组织,然后通过特定波长的激光照射使肿瘤组织吸收的光敏剂受到激发,产生光化学反应,产生具有细胞毒性作用的单态氧和自由基,直接引起肿瘤细胞坏死,凋亡,达到杀灭肿瘤病灶,使得胆道再通的目的。

3、光动力适合哪些胆管癌患者?

根据目前国内治疗经验,胆管癌虽然发病率不高,但是由于缺乏有效治疗手段,很多不可手术的胆管癌患者目前都只是单纯放支架引流,这部分患者如果想进一步对肿瘤进行治疗,延长支架通畅时间,是可以考虑进行光动力治疗,还有些患者已经做了粒子支架,放化疗,或者射频消融,但是仍不能控制病情进展,也可以考虑光动力治疗,还有就是由于年龄,身体等原因无法耐受手术,放化疗等其他副作用较大疗法的患者,可以考虑光动力治疗。

4、光动力除了治疗胆管癌以外,还适合哪些患者呢?

光动力治疗在消化系统肿瘤特别是食管癌、胃癌、结直肠癌、胆管癌、十二指肠乳头癌等的治疗中具有显著的疗效,对于不能手术、放疗、化疗者,能减轻痛苦、延长生命、改善生存质量,并且可以协同外科手术消灭病灶周围残存的微小病灶,提高手术彻底性,减少肿瘤的复发。它的出现,开启了内镜激光微创治疗肿瘤的新篇章。

                                  供稿:消化内镜科

                                  编辑:宣传科

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