胆管支架置入联合锁骨下动脉药盒贯序化疗治疗肝门部胆管癌:不同种类支架选择对治疗效果有影响吗?  

Biliary tract stents implantation combined with percutaneous portcatheter system in treating hilar cholangiocarcinoma: Does the selection of stent types have effect on therapeutic efficacy?

作　　者：谭志刚[1] 郭奕彤[2] 

机构地区：[1]沈阳医学院奉天医院急诊科,辽宁省沈阳市110024 [2]沈阳市第九人民医院内六科,辽宁省沈阳市110024

出　　处：《中国组织工程研究与临床康复》2009年第52期10377-10381,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:目前普遍认为肝门部胆管癌的处理是在胆道造影的基础上,行胆道支架置入可达到与手术切除同样的远期治疗效果,由于全身化疗或体外放疗的效果均不满意,通过胆道支架置入联合左锁骨下动脉贯序化疗能达到较好的临床效果。目的:归纳总结胆管支架置入并锁骨下动脉化疗治疗肝门部胆管癌的临床方法,以及支架置入后与宿主的生物相容性。方法:用计算机检索PubMed、Cochrane图书馆、CNKI和VIP,检索时间截止至2009-08。以中位生存时间、黄疸减退率、并发症率、支架与宿主生物相容性为评价指标。纳入胆管支架并锁骨下动脉化疗治疗肝门部胆管癌的临床研究;排除动物实验。计算机初检得到156篇文献,保留25篇做进一步分析;并对临床效果进行总结。结果与结论:体外实验证明,应用含抗生素的材料制作支架、含银材料支架以及某些具有抑制大肠埃希菌的生物材料做支架或涂于支架内层,可以预防细菌的附着,但临床应用尚不理想。壳聚糖是一种天然的阳离子多聚物,具有良好的生物相容性、抗菌性和生物可降解性。应用胆管支架并锁骨下动脉化疗治疗肝门部胆管癌临床验证结果,42例患者切除组与支架引流组比较,支架引流组术后黄疸消退较快、有效率较高,但是差别没有显著性。Kaplan-Meier生存分析显示切除组7例中位生存期为16个月。1,3,5年生存率分别为57.1%(4/7),28.6%(2/7),14.3%(1/7);双介入组患者19例中位生存期为18个月,1,3,5年生存率为52.6%(10/19),27.8%(5/19),15.8%(3/19);对照组患者14例中位生存期为12个月,1,3,5年生存率分别为57.1%,28.6%,14.2%。证实胆管支架并锁骨下动脉化疗治疗肝门部胆管癌确能提高患者生活质量,延长生存期。BACKGROUND： It generally thought that based on cholangiography, biliary tract stents implantation can achieve a same long-term therapeutic efficacy as resection, and obtain good clinical outcomes in treating hilar cholangiocarcinoma when combined with percutaneous portcatheter system. OBJECTIVE： To evaluate the clinical methods of double interventional therapy and the biocompatibility between stent and host in hilar cholangiocarcinoma following stent implantation. METHODS： The databases of MEDLINE, Cochrane library, CNKI and VIP were retrieved with deadline of August 2009. Medium survival time and jaundice decrease rate, complication rate as well as biocompatibility between stent and host were served as assessment index. Clinical studies addressing double interventional therapy for treating proximal bile duct cancer were included, and animal studies were excluded. A total of 156 literatures were obtained initially by computer, and 25 literatures were included in further analysis. RESULTS AND CONCLUSION： In vitro test showed that stents carrying antibiotic, silver, or Escherichia coli, which may prevent adhesion of bacteria, however, it obtained poor clinical results. Chitosan is a natural cationic polymer and possess good biocompatibility, antibiosis and biodegradability. For the compare of the therapeutic effectiveness among different surgical procedure, it found that the decrease of total bilirubin were more faster in the internal and external drainage group than the resection group, however, the difference had no statistically significance. According to the Kaplan-Meier survival analysis, the medium survival time of 7 patients in the resection group was 16 months. The 1, 3, 5 years survival rate were 57.1%（4/7）, 28.6%（2/7） ,14.3%（1/7）, respectively. Among the double interventional therapy group, the medium survival time of 19 patients was 18 months, and the 1, 3, 5 years survival rate were 52.6%（10/19）, 27.8%（5/19）, 15.8%（3/19）, respectively. The medium survival time was 12 mont

关 键 词：胆管癌(肝门部) 胆管支架 生物相容性材料 

分 类 号：R318[医药卫生—生物医学工程]