光動力療法治療膽管癌的系統評價_《中國循證醫學雜志》

作者：

任延剛 ,  郭啟勇 , 盧再鳴

中國醫科大學附屬盛京醫院放射科（沈陽 110114）;

關鍵詞：

光動力療法不可切除膽管癌療效系統評價

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目的　系統評價光動力療法（photodynamic therapy，PDT）姑息治療不可切除膽管癌的有效性和安全性。
方法　計算機檢索Cochrane圖書館CENTRAL 2006年第4期、MEDLINE（1966~2007.2）、CNKI（1994~2007.2）和VIP（1989~2007.2）。按Cochrane系統評價方法評價納入研究質量，并進行描述性分析。
結果　共納入兩個隨機對照試驗（RCT），包括71例患者。結果顯示，兩個RCT的PDT+支架組中位生存時間均遠長于單用內置支架組，其差異有統計學意義（P lt;0.01）。1個RCT顯示，PDT組總體生存質量明顯優于單用支架組，兩組差值25.4（14.4~36.3）；1個RCT顯示，兩組Karnofsky指數均無改變。未發現PDT有任何嚴重副作用。
結論　現有證據表明，光動力治療不可切除膽管癌可延長患者生存時間，降低治療負擔，但可能增加膽道感染率；對于后者，可用抗菌治療加以控制，余無其他嚴重副作用，施術者內鏡技術熟練即可實施此療法。鑒于本系統評價僅納入兩個RCT，且例數較少，因此所得結果尚需更多大樣本RCT加以驗證。

引用本文： 任延剛,郭啟勇,盧再鳴. 光動力療法治療膽管癌的系統評價. 中國循證醫學雜志, 2007, 07(6): 456-460. doi: 復制

1.	Anderson CD, Pinson CW, Berlin J, et al. Diagnosis and treatment of cholangiocarcinoma. Oncologist, 2004, 9(1): 43-57.
2.	de Groen PC, Gores GJ, LaRusso NF, et al. Biliary tract cancers. N Engl J Med, 1999, 341(18): 1368-1378.
3.	Chamberlain RS, Blumgart LH. Hilar cholangiocarcinoma: a review and commentary. Ann Surg Oncol, 2000, 7(1): 55-66.
4.	Speer AG, Cotton PB, MacRae KD. Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. Gastrointest Endosc, 1988, 34(5): 412-417.
5.	Polydorou AA, Cairns SR, Dowsett JF, et al. Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. Gut, 1991, 32(6): 685-689.
6.	McCaughan JS, Mertens BF, Cho C, et al. Photodynamic therapy to treat tumors of the extrahepatic biliary ducts. A case report. Arch Surg, 1991, 126(1): 111-113.
7.	Ortner MA, Liebetruth J, Schreiber S, et al. Photodynamic therapy of nonresectable cholangiocarcinoma. Gastroenterology, 1998, 114(3): 536-542.
8.	Berr F, Wiedmann M, Tannapfel A, et al. Photodynamic therapy for advanced bile duct cancer: evidence for improved palliation and extended survival. Hepatology, 2000, 31(2): 291-298.
9.	Wiedmann M, Berr F, Schiefke I, et al. Photodynamic therapy in patients with non-resectable hilar cholangiocarcinoma: 5-year follow-up of a prospective phase II study. Gastrointest Endosc, 2004, 60(1): 68-75.
10.	Zoepf T, Jakobs R, Arnold JC, et al. Photodynamic therapy for palliation of nonresectable bile duct cancer--preliminary results with a new diode laser system. Am J Gastroenterol, 2001, 96(7): 2093-2097.
11.	Harewood GC, Baron TH, Rumalla A, et al. Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma. J Gastroenterol Hepatol, 2005, 20(3): 415-420..
12.	Ortner ME, Caca K, Berr F, et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology, 2003, 125(5): 1355-1363.
13.	Zoepf T, Jakobs R, Arnold JC, et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol, 2005, 100(11): 2426-2430.

1. Anderson CD, Pinson CW, Berlin J, et al. Diagnosis and treatment of cholangiocarcinoma. Oncologist, 2004, 9(1): 43-57.
2. de Groen PC, Gores GJ, LaRusso NF, et al. Biliary tract cancers. N Engl J Med, 1999, 341(18): 1368-1378.
3. Chamberlain RS, Blumgart LH. Hilar cholangiocarcinoma: a review and commentary. Ann Surg Oncol, 2000, 7(1): 55-66.
4. Speer AG, Cotton PB, MacRae KD. Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. Gastrointest Endosc, 1988, 34(5): 412-417.
5. Polydorou AA, Cairns SR, Dowsett JF, et al. Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. Gut, 1991, 32(6): 685-689.
6. McCaughan JS, Mertens BF, Cho C, et al. Photodynamic therapy to treat tumors of the extrahepatic biliary ducts. A case report. Arch Surg, 1991, 126(1): 111-113.
7. Ortner MA, Liebetruth J, Schreiber S, et al. Photodynamic therapy of nonresectable cholangiocarcinoma. Gastroenterology, 1998, 114(3): 536-542.
8. Berr F, Wiedmann M, Tannapfel A, et al. Photodynamic therapy for advanced bile duct cancer: evidence for improved palliation and extended survival. Hepatology, 2000, 31(2): 291-298.
9. Wiedmann M, Berr F, Schiefke I, et al. Photodynamic therapy in patients with non-resectable hilar cholangiocarcinoma: 5-year follow-up of a prospective phase II study. Gastrointest Endosc, 2004, 60(1): 68-75.
10. Zoepf T, Jakobs R, Arnold JC, et al. Photodynamic therapy for palliation of nonresectable bile duct cancer--preliminary results with a new diode laser system. Am J Gastroenterol, 2001, 96(7): 2093-2097.
11. Harewood GC, Baron TH, Rumalla A, et al. Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma. J Gastroenterol Hepatol, 2005, 20(3): 415-420..
12. Ortner ME, Caca K, Berr F, et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology, 2003, 125(5): 1355-1363.
13. Zoepf T, Jakobs R, Arnold JC, et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol, 2005, 100(11): 2426-2430.

《中國循證醫學雜志》

光動力療法治療膽管癌的系統評價

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《中國循證醫學雜志》

光動力療法治療膽管癌的系統評價

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