光动力疗法对中晚期梗阻性食管癌的治疗作用-肿瘤学专业论文.docxVIP

汕头大学医 汕头大学医学院硕士学位论文 中文摘要 背景与目的 光动力治疗是一种新的肿瘤微创治疗方法，通过光动力反应使肿瘤组织在短时间内出 现坏死脱落。本文通过 34 例中晚期梗阻性食管癌光动力治疗后的疗效评价，探讨光动力 治疗在中晚期梗阻性食管癌治疗中的优势。 材料与方法 Ⅲ、Ⅳ期食管癌 34 例，均伴有不同程度吞咽困难。以加拿大产光敏剂 photofrin 2mg/kg 静脉滴注，48h 及 72h 后采用英国产 DIOMED 630 型半导体激光治疗仪，通过内镜导入 光纤，在内镜直视下对准病灶，以 300J/cm 能量水平进行照射。内镜检查评价治疗前、第 一次光照后及治疗 1 个月后食管病灶的变化情况；临床评价比较患者治疗前后吞咽困难与 体力状况（KPS 评分）的改善情况；观察有无 PDT 相关并发症，评价其安全性。 结果 34 例患者在第一次光照后均可见不同程度肿瘤坏死，治疗后 1 个月疗效评定，无 CR 病例，SR 28 例（82.3 %），MR 4 例（11.8 %），NR 2 例（5.9%），总有效率（CR+SR）为 82.3 %。治疗后吞咽困难症状得以明显改善，评分由平均 1.82 级降至 0.44 级，差异具有 统计学意义（P＜0.001）。KPS 评分由治疗前平均 50.58±6.00 分（40-60 分），提高到治 疗后 1 个月平均 73.82±8.88 分（50-90 分），差别具有统计学意义（P＜0.001）。无严重并 发症发生。 结论 光动力治疗中晚期梗阻性食管癌能使肿瘤组织在短时间内坏死脱落，有效解除食管梗 阻，改善患者生活质量和提高全身体力状况，是一种起效快、效果好、安全性高的微创治 疗方法。 关键词 光动力疗法； 中晚期食管癌； 梗阻 I Abstact BACKGROUND AND OBJECTIVES Photodynamic therapy (PDT) is a novel technique for tumor minimally invasive treatment, that induces necrosis and exfoliation of the tumor tissue within a short time by photodynamic reaction. To explore the advantages of PDT for obstructing esophageal carcinoma, we performed a retrospective study to evaluate the efficacy of PDT in 34 patients diagnosed advanced esophageal carcinoma with obstruction. MATERIALS AND METHODS 34 patients diagnosed stage Ⅲ or Ⅳ esophageal carcinoma with some degree of dysphagia were treated with intravenous administration of Photofrin (produced in Canada) as the photosensitizer at a dose of 2mg/kg. Laser irradiation at 300 J/cm was performed through optical fiber（DIOMED 630 PDT system produced in England）that passed through the endoscope after 48 h and 72 h. Endoscopic evaluation of the esophageal lesion was conducted before the treatment, after the first time of irradiation and 1 month later. The degree of dysphagia and performance Status (KPS Scale）before and after treatment were compared. We also evaluate the safety by observing complications after PDT. RESULTS Tumor necrosis in different degree is visible in all of the 34 patients after the first time of