经皮经肝胆道引流联合全身静脉化疗治疗中晚期胰腺癌合并梗阻性黄疸  

Percutaneous Transhepatic Cholangial Drainage Combined with Chemotherapy in Treatment of Locally Advanced or Metastatic Pancreatic Cancer with Obstructive Jaundice

作　　者：王国宝[1] 范卫君[2] 林旭滨[1] 陈晓勤[1] 吕跃[1] 

机构地区：[1]中山大学肿瘤防治中心//华南肿瘤学国家重点实验室内科,广东广州510060 [2]中山大学肿瘤防治中心//华南肿瘤学国家重点实验室影像介入科,广东广州510060

出　　处：《中山大学学报（医学科学版）》2009年第3期326-330,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省中医药管理局科研基金(1050167)

摘　　要：【目的】探讨经皮经肝胆道引流(PTCD)联合全身静脉化疗治疗中晚期胰腺癌合并梗阻性黄疸的临床价值。【方法】回顾性分析23例中晚期胰腺癌合并梗阻性黄疸的患者。所有患者先进行PTCD解除胆道梗阻症状,待血清胆红素指标明显改善后,12例采用吉西他滨联合顺铂全身化疗,11例采用吉西他滨联合草酸铂全身化疗。分析PTCD疗效、化疗有效率、生存期及不良反应。【结果】血清总胆红素由PTCD术前(157±11)μmol/L降至术后(35±4)μmol/L(P<0.001);化疗后部分缓解6例,稳定6例,进展11例,化疗有效率为26.1%;总临床受益反应为60.9%;中位无进展生存期为5.2个月;中位生存期为8.2个月;GP与GEMOX方案组化疗有效率、无进展生存期、中位生存期差异无明显统计学意义(P>0.05);化疗不良反应中骨髓抑制的总发生率为78.3%,消化道反应为69.6%,肝、肾功能损害及外周神经毒性均为Ⅰ、Ⅱ度,无化疗相关的死亡。【结论】经皮经肝胆道引流联合全身静脉化疗是中晚期胰腺癌合并梗阻性黄疸的安全、可行的治疗方法。[Objective] To discuss the clinical value of percutaneous transhepatic cholangial drainage （PTCD） combined with chemotherapy as the treatment for locally advanced or metastatic pancreatic cancer with obstructive jaundice. [Methods] Twenty- three patients who suffered from locally advanced or metastatic pancreatic cancer with obstructive jaundice were analyzed retrospectively. The regimen was administered to the patients after the symptoms of obstruction of biliary tract were relieved as well as the value of serum bilirubin was obviously decreased. 12 patients received Gemcitabine and cisplatin, and 11 patients received Gemcitabine and oxaliplatin. Then to analyze effect, and complications of PTCD, overall survival, efficacy and toxicity of chemotherapy. [Results] Of the 23 patients, Total serum bilirubin was decreased from 157 ± 11 μmol/L to 35 ± 4 μmol/L after PTCD （P 〈 0.001）. 6 achieved partial remission, 6 had stable disease, and 11 had progressive disease. The objective response rate was 26.1%. The proportion of clinical benefit response was 60.9%. The PFS was 5.2 months and median overall survival was 8.2 months. There was no significant difference between the GP group and the GEMOX group （P〉0.05）. The total occurrence rate of myelosuppression was 78.3%. The occurrence rate of gastrointestinal adverse events was 69.6%, Liver function damage renal function damage and peripheral neurotoxicity were grade Ⅰ -Ⅱ. No chemotherapy-related death occurred.. [Conclusion] PTCD combined with chemotherapy is a safe and feasible therapy for locally advanced or metastatic pancreatic cancer with obstructive jaundice.

关 键 词：胰腺癌 梗阻性黄疸 经皮经肝胆道引流 化疗 

分 类 号：R73[医药卫生—肿瘤]