上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

单纯胆道支架与支架联合125I粒子条植入治疗恶性梗阻性黄疸

赵苏鸣1，赵辉1，顾潍炜1，杨晓虎1，贾鹏飞2   

  1. 南通大学附属医院 1.介入放射科； 2.放疗科， 南通 226001
  • 出版日期:2015-11-28 发布日期:2016-01-13
  • 通讯作者: 赵辉, 电子信箱: zhaohui800@126.com。
  • 作者简介:赵苏鸣（1978—）, 男， 副主任医师， 硕士; 电子信箱: 951245999@qq.com。
  • 基金资助:

    南通市科技项目(BK2013068)

Treatment of malignant obstructive jaundice by biliary stent and biliary stent combined with 125I seed implantation

ZHAO Su-ming1, ZHAO Hui1, GU Wei-wei1, YANG Xiao-hu1, JIA Peng-fei2   

  1. 1.Department of Interventional Radiology, 2.Department of Radiotherapy, the Affiliated Hospital of Nantong University, Nantong 226001, China
  • Online:2015-11-28 Published:2016-01-13
  • Supported by:

    Science and Technology Project of Nantong, BK2013068

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摘要：

目的  探讨经皮经肝胆管引流单纯胆道支架植入与支架联合胆道腔内125I粒子条植入治疗恶性梗阻性黄疸的临床疗效的差异。方法  62例恶性梗阻性黄疸患者行经皮经肝胆管引流(PTCD)后随机分为2组(n=31)：对照组行单纯胆道支架植入，实验组行胆道支架联合125I粒子条植入。比较两组患者术前与术后黄疸消退、肿瘤复发情况、血清肿瘤标志物CA199的水平及生存情况。结果  62例患者手术均成功。两组患者PTCD术前及支架植入术后1周血清总胆红素测定差异无统计学意义（P>0.05）。术后1、3个月实验组血清总胆红素明显低于对照组（P<0.05）。随访期内，再次发生胆道梗阻的实验组3例，对照组14例（P>0.05）。实验组术后1~2周，血清肿瘤标志物CA199水平较术前明显降低（P<0.05）。实验组患者中位生存时间11个月，对照组患者中位生存时间7个月，两组差异有统计学意义（P<0.05）。结论   与单纯胆道支架植入治疗恶性梗阻性黄疸相比，胆道支架联合胆道腔内125I粒子条植入照射在黄疸消退、抑制肿瘤生长及延长患者生存时间等疗效方面显示出一定的优越性，有望在临床推广应用。

关键词: 经皮经肝胆管引流, 恶性梗阻性黄疸, 胆道支架, 125I粒子

Abstract:

Objective  To investigate the difference of clinical therapeutic effect between percutaneous transhepatic cholangial drainage (PTCD) by biliary stent and biliary stent combined with 125I seed implantation for the treatment of patients with malignant obstructive jaundice. Methods  A total of 62 patients with malignant obstructive jaundice were randomly divided into the control group (n=31) and treatment group (n=31) after undergoing PTCD. Patients of the control group underwent biliary stent implantation and those of the treatment group underwent biliary stent combined with 125I seed implantation. The subsidence of jaundice, tumor recurrence, level of serum tumor marker CA199, and survival time of two groups before and after treatment were compared. Results  Operations of all patients were successful. The differences of the level of serum total bilirubin between two groups before PTCD and 1 week after stent implantation were not statistically significant (P>0.05). The levels of serum total bilirubin of the treatment group 1 and 3 months after operation were significantly lower than those of the control group (P<0.05). Three patients of the treatment group and 14 patients of the control group suffered the biliary obstruction recurrence during the follow-up period (P>0.05). The level of serum tumor marker CA199 of the treatment group 1 or 2 weeks after operation was significantly lower than that before operation (P<0.05). The median survival time of the treatment group and control group was 11 and 7 months and the difference was statistically significant (P<0.05). Conclusion  Compared with treatment of PTCD by biliary stent, the combination of biliary stent and 125I seed implantation is better in terms of subsidence of jaundice, inhibition of tumor growth, and increase of survival time and is hopeful for clinical applications.

Key words: percutaneous transhepatic cholangial drainage, malignant obstructive jaundice, biliary stent, 125I seed