经皮肝穿胆道引流术联合^(125)I粒子植入治疗晚期胰腺癌合并梗阻性黄疸  

PTCD combined with 125I seed implantation for the treatment of advanced pancreatic cancer associated with obstructive jaundice

作　　者：赵晓阳[1] 曹会存[2] 李天晓[2] 王振豫[2] 曹广劭[2] 刘健[2] 王玉丹[2] 刘建文[2] 

机构地区：[1]郑州大学第一附属医院 [2]郑州大学河南省人民医院介入治疗中心

出　　处：《介入放射学杂志》2013年第8期650-654,共5页Journal of Interventional Radiology

摘　　要：目的评价经皮肝穿胆道引流术(PTCD)联合125I粒子植入治疗晚期胰腺癌合并梗阻性黄疸的近期疗效和安全性。方法 23例晚期胰腺癌合并梗阻性黄疸患者,均经临床、CT、MRI检查和病理活检后明确诊断。所有患者先在DSA下行PTCD,1周后在CT下行胰腺癌病灶放射性125I粒子植入。统计患者临床症状改善情况,肿瘤大小变化,术后并发症等。结果 1个月后23例患者黄疸均现减退,血清胆红素较术前明显下降(P<0.01);临床表现明显疼痛的19例患者中8例患者疼痛完全缓解,8例患者部分缓解,3例无效,疼痛缓解有效率为84.2%。2个月后CT复查,实体肿瘤2例完全缓解,12例部分缓解,4例无变化,5例疾病进展。随访过程中未出现与手术相关重症胰腺炎、胰漏、肠道出血等严重并发症。结论PTCD联合125I粒子植入治疗晚期胰腺癌合并梗阻性黄疸患者安全、有效,能够短时间内改善黄疸症状,控制肿瘤生长,并且具有较好的姑息性止痛效果,明显改善患者生活质量,是一种有效、值得推广的方法。Objective To evaluate the short-term effect and clinical safety of percutaneous transhepatic cholangiopancreatic drainage（PTCD） combined with 125I seed implantation in treating advanced pancreatic cancer associated with obstructive jaundice.Methods A total of 23 patients with advanced pancreatic cancer complicated by obstructive jaundice were enrolled in this study.The patients included 18 males and 5 females,and the age varied from 40 to 82 years with a mean of 66.8 years.The diagnosis was confirmed by CT,MRI and biopsy in all patients.Clinically,obvious jaundice was seen in each patient.The serum bilirubin level was determined before and after the treatment.DSA-guided PTCD was performed first,and one week later CT-guided 125I seed implantation was carried out.After the treatment,the improvement of clinical condition,the change in tumor size and the occurrence of complications were recorded.The results were analyzed.Results One month after the treatment,the jaundice significantly faded away in all 23 patients,with serum bilirubin level being significantly decreased when compared with that determined before treatment（P 0.001）.Complete relief of pain was obtained in 8 cases and partial relief of pain was obtained in another 8 cases,but in three patients the pain severity remained the same as before.The relief rate of pain was 84%.CT scanning performed two months after 125I seed implantation showed that complete remission of the solid tumor was seen in 2 cases and partial remission in 12 cases,while the tumor was unchanged in 4 cases and deteriorated in 5 cases.During the follow-up period,no serious complications such as procedure related severe acute pancreatitis,pancreatic leakage,intestinal bleeding,etc.occurred.Conclusion For the treatment of advanced pancreatic cancer with obstructive jaundice,PTCD combined with 125I seed implantation is safe,simple and effective.This therapy can quickly alleviate the jaundice and control the growing of tumor.Besides,it can effectively relieve pain and markedly improve

关 键 词：胰腺癌 梗阻性黄疸 PTCD 125I粒子 

分 类 号：R735.9[医药卫生—肿瘤]