金属内支架胆管引流与放射治疗结合治疗肝外胆管癌  

Outcome of self-expanding metal stenting followed by radiation therapy for unresectable extrahepatic bile duct cancer

作　　者：金晶[1] 翟仁友[2] 高黎[1] 余子豪[1] 韩嘉珠[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院放疗科,北京100021 [2]首都医科大学附属北京朝阳医院放射科

出　　处：《介入放射学杂志》2007年第10期699-702,共4页Journal of Interventional Radiology

基　　金：国家十一五课题资助项目(2007BAI05B06)

摘　　要：目的回顾性分析局部晚期肝外胆管癌金属内支架胆管引流结合放射治疗的疗效。方法1996年1月至2002年9月收治17例不能手术切除肝外胆管癌患者,先接受金属支架行胆管引流,3例治疗1周内失访,其余14例单纯近距离放疗(近距离照射组,n=5)或外照射(外照射组,n=9,其中包括2例近距离+外照射)。Ir192高剂量率近距离放疗在金属内支架置入当天或隔天治疗。外照射的中位剂量48Gy(14～66Gy),2Gy/次。结果经金属内支架置入结合放疗后,10例黄疸患者中8例黄疸消褪,近距离和外照射对缓解黄疸症状无显著差别。全组中位生存期12个月(5～35个月),1、2年生存率分别为40.8%和8.2%。近距离治疗组与体外照射组的中位生存期、1、2年生存率分别为8个月、40.0%、20.2%和12个月、40.0%、13.3%(χ2=1.10,P=0.29)。结论金属内支架胆管引流结合放射治疗可以显著缓解黄疸症状,高剂量放射治疗可以进一步提高长期生存。Objective To retrospectively analyze the efficacy for self-expanding metal stenting followed by radiation therapy for unresectable extrahepatic bile duct cancer. Methods From Jan 1996 to Sep 2002, 17 patients were treated with self-expanding metal stenting followed by Ir^192 high dose brachytberapy （brachytherapy group, n = 5）and by external beam radiation therapy（external radiation therapy group, n = 9）. Brachytberapy was delivered on the same day or the following day after stenting with the total dose of DT 20 - 30 Gy, twice daily, for 2 - 3 days. The median total dosage of external radiation therapy was 48 Gy（14 - 66 Gy）,2 Gy/fraction. Results Jaundice was released after metal stenting from 71.4% to 14.3%（P = 0.001）, showing no significant difference between brachytherapy and external radiation therapy in terms of jaundice release（χ^2 = 0.21 ,P = 0.65）. The median survival period（5 - 35 months）for whole groups was 12 months 1-, 2-year survival rates were 40.8% and 8.16%, respectively. No significant difference was shown for patients received either brachytherapy or external radiation therapy for 8 months, but with 1,2 year survival rate as 40.0%, 13.3%, respectively （χ^2 = 1.10,P = 0.29）. Condusions Self-expanding metal stenting is able to release jaundice significantly and followed by high dose radiation therapy may further prolong the survival.

关 键 词：肝外胆管癌 放射治疗 近距离治疗 金属内支架 

分 类 号：R735.8[医药卫生—肿瘤]