Cholangiocarcinoma is a rare, highly aggressive malignancy of the hepatobiliary tract with poor prognosis, often diagnosed at advanced stages when curative surgical resection is not feasible. Management increasingly relies on advanced endoscopic interventions to address malignant biliary obstruction and improve clinical outcomes. Beyond conventional biliary stenting, adjunctive endoscopic ablation therapies have emerged as promising strategies to improve both stent patency and survival. This review comprehensively examines the evolving role of radiofrequency ablation and photodynamic therapy in the treatment of unresectable cholangiocarcinoma. Radiofrequency ablation utilizes localized thermal energy to induce coagulative tumor necrosis and offers advantages including procedural simplicity, favorable safety profile, and cost-effectiveness; however, its efficacy may be limited by tumor size, location, and proximity to critical structures. In contrast, photodynamic therapy employs light-activated photosensitizers to selectively induce cytotoxicity in malignant tissue, demonstrating superior outcomes in prolonging both stent patency and overall survival across multiple studies and meta-analyses. Photodynamic therapy’s ability to treat more diffuse and peripheral lesions represents an important advantage, though its use is limited by photosensitivity reactions and shallow tissue penetration. Ultimately, endoscopic ablation therapies represent valuable adjunctive options in the multidisciplinary care of patients with unresectable cholangiocarcinoma. As technological advances continue and more comparative data emerge, optimized patient selection and individualized integration of these therapies hold potential to significantly improve outcomes in this challenging malignancy.
胆管癌是一种罕见且高度侵袭性的肝胆道恶性肿瘤，预后较差，常在晚期确诊，此时根治性手术切除已不可行。临床处理日益依赖于先进的内镜介入技术，以应对恶性胆道梗阻并改善临床结局。除传统胆道支架置入外，辅助性内镜消融疗法已成为提高支架通畅率和患者生存率的前瞻性策略。本文全面探讨了射频消融与光动力疗法在不可切除胆管癌治疗中不断演进的临床价值。射频消融利用局部热能诱导肿瘤凝固性坏死，具有操作简便、安全性良好及成本效益较高等优势；但其疗效可能受肿瘤大小、位置及邻近关键解剖结构的限制。相比之下，光动力疗法通过光敏剂的光活化作用选择性诱导恶性组织细胞毒性，多项研究及荟萃分析显示其在延长支架通畅期和总体生存期方面具有更优效果。该疗法对弥漫性及外周性病灶的治疗能力构成其重要优势，但其应用受限于光敏反应及组织穿透深度较浅等问题。总体而言，内镜消融疗法为不可切除胆管癌的多学科综合治疗提供了重要的辅助选择。随着技术进步和比较数据的积累，优化患者选择并实现个体化治疗整合，有望显著改善这一难治性恶性肿瘤的临床结局。
肿瘤(癌症)患者之家