Cholangiocarcinoma is a malignant tumor originating from the epithelial cells of the bile ducts, due to the insidious onset of the disease, the opportunity for radical surgery has been lost when the diagnosis is confirmed, and cholangiocarcinoma is not sensitive to chemotherapy and radiation therapy, and the prognosis is poor. Radical surgery is the only cure, but the radical resection rate of hilar cholangiocarcinoma is low, less than 20%, and the surgical trauma is large, the postoperative complications are more, and the treatment cost is relatively high; for non-surgical or distantly metastasized cholangiocarcinoma, systematic chemotherapy is still the first-line choice, but the prolonged survival of chemotherapy is limited; the status of radiotherapy in the clinical treatment of cholangiocarcinoma is still controversial; at present, we can only use some palliative treatment, such as biliary stent drainage, Biliary drainage is a commonly used treatment method for the clinical treatment of biliary tract tumors, although it can effectively alleviate obstructive jaundice, but biliary drainage alone is not enough to slow down the growth of tumors. Photodynamic therapy refers to the corresponding wavelength of laser, excitation of photosensitizers gathered in tumor tissue, photodynamic chemical reaction with the participation of oxygen in biological tissues, the production of monomorphic oxygen and oxygen free radicals, so that tumor cells destroy, apoptosis of the treatment method. Photodynamic therapy is a minimally invasive, accurate local treatment of tumors, which can retain the structure and function of tissues and organs, improve the quality of life of patients, and has played an important role in the treatment of a variety of malignant tumors, especially to make up for the lack of traditional treatment of cholangiocarcinoma, and provide a new direction for the treatment of patients with bile duct cancer. The Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University was photodynamically treated with a PTBD tube in a patient with advanced hilar cholangiocarcinoma, and the effect was remarkable at four months after surgery. Shi Mou, male, 75 years old, from Xi'an City, Shaanxi Province, height: 170cm, weight: 78kg, main complaint of yellow staining of the skin sclera with loss of appetite for more than 2 weeks. More than 2 weeks ago, the patient had no obvious cause of yellow skin sclera, dark yellow urine, poor appetite, fullness after eating, fearless cold fever, no nausea and vomiting, no diarrhea and constipation, no vomiting and other discomfort, visited the local hospital, checked the liver function to indicate a significant increase in bilirubin, and the patient came to our hospital for further treatment. Ct enhancement of the epigastric region suggests thickening and significant strengthening of the walls of the common hepatobic duct and common bile duct; The UPPER MR suggests: the upper and posterior segments of the common bile duct duodenum, the common hepatic duct, the right hepatic duct and the intrahepatic bile duct are diffuse thickened, the signal is slightly higher on the DWI high b value, and the upstream bile duct is significantly expanded; for further treatment, I was admitted to our department. Complete examination after admission, CA199 2576 ng/ml, AST: 108U/L, ALT: 163U/L, TBIL: 399 umol/L. Clinical diagnosis is: obstructive jaundice, hepatic hilar cholangiocarcinoma (III.a). Immediately after admission, percutaneous transhepatic left and right hepatic duct drainage is arranged. Traditional treatments are not suitable for elderly patients. After three-dimensional visualization image reconstruction, combined with ICG 15min retention rate (42.5%), it cannot be surgically resected after comprehensive evaluation, and the effect of radiotherapy and chemotherapy is limited. Professor Lv Yi, an expert in hepatobiliary surgery in our hospital, has seen the patient's situation, fully communicated with the patient and his family, suggested that the patient undergo local minimally invasive treatment, and then invited Professor Gu Ying, a well-known laser medicine expert in China and academician of the Chinese Academy of Sciences, to visit our hospital in person, after preoperative discussion and full preparation, the patient underwent tumor targeted photodynamic therapy on June 15, and the route was selected percutaneous transhepatic puncture and drainage route, the light parameters were 100mw/cm2, and the irradiation time was 900s.
Planning and design of preoperative surgical protocols
Follow-up CT at 1 month after surgery showed that the treatment effect of lesions in the right hepatic duct, common hepatic tube and lower common bile duct was remarkable, the level of bilirubin decreased significantly compared with before surgery, the tumor marker CA199 decreased significantly compared with preoperative, and the patient's mental state improved significantly compared with before. The patient underwent the second photodynamic therapy on August 4, the route was selected by the ERCP route, the light parameter was 100mw/cm2, the irradiation time was 900s, and the patient removed the extrahepatic drainage tube after surgery, and the quality of life was significantly improved compared with before. The degree of tertiary strengthening of the above lesions was significantly reduced in postoperative re-examination, and the patient's condition was stable.
Tumor markers and bilirubin changes
Imaging changes before and after photodynamic therapy
Photodynamic therapy is a new choice for patients with advanced cholangiocarcinoma, which uses minimally invasive means to achieve the purpose of "removing" tumor lesions and re-connecting the biliary tract. At present, our hospital has carried out nearly 10 cases. At present, the indications for patients who can take photodynamic therapy in hepatobiliary surgery are: 1) biliary tract tumors with extensive or violation of important vascular nerves causing incurable surgical resection; 2) patients who cannot tolerate tumor resection surgery due to advanced age or complications; 3) palliative surgery or postoperative tumor recurrence; 4) patients with bile duct obstruction or bile duct stenting recurrence in tumor patients; 5) it also has a good effect on ampullar tumors such as duodenal papillary cancer.