125I 粒子条胆道支架治疗恶性胆道梗阻38例  

Percutaneous implantation of ^(125)I seed-strip combined with biliary stent for the treatment of malignant biliary obstruction: analysis of 38 cases

作　　者：黄兢姚[1] 杨维竹[1] 江娜[1] 郑曲彬[1] 黄宁[1] 谢杭[1] 

机构地区：[1]福州福建医科大学附属协和医院介入科,350001

出　　处：《介入放射学杂志》2014年第7期633-636,共4页Journal of Interventional Radiology

摘　　要：目的研究恶性胆道梗阻患者在施行经皮胆道支架成形术的基础上,经胆道支架内植入放射性粒子条治疗恶性胆道梗阻的疗效。方法 38例恶性胆道梗阻的患者,应用125I粒子,每个125I粒子长4.5 mm、直径0.8 mm,送入导管制备粒子条。先行经皮胆道引流术(PTCD)术;将导丝经皮通过梗阻段,先行球囊导管扩张,后行经皮胆道支架成形术;然后经支架置入8~10 F胆道引流管;最后将装有粒子条的导管在透视下经胆道引流管送入所需照射部位,包敷固定引流管露出体外部分或者包埋于皮下。结果38例胆道恶性梗阻的患者中36例成功施行经皮胆道支架成形术及放射性粒子条植入术,术后患者血清胆红素均降至正常或接近正常(P<0.05)。未出现明显不良反应。结论临床观察发现经皮胆道支架成形术后联合放射性粒子条置入术治疗恶性胆道梗阻是一种安全有效的方法。Objective To investigate the clinical efficacy of percutaneous transhepatic insertion of biliary stent （PTIBS） combined with radioactive seed implantation in treating malignant biliary obstruction. Methods A total of 38 patients with malignant biliary obstruction were enrolled in this study. Radioactive 125I seed was used, and each 125I seed was 4.5 mm in length and 0.8 mm in diameter. The 125I seeds were placed in a catheter to prepare the 125I seed- strip. PTCD was carried out first, then percutaneous catheterization was performed and a guide- wire was inserted through the catheter until it passed the obstructed biliary segment. The obstructed segment was dilated by a balloon - catheter, which was followed by PTIBS. An 8 - 10 F drainage - catheter was placed into the biliary duct through the stent. Finally, guided by fluoroscopy the catheter with the 125I seed- strip was inserted via the drainage- catheter to the area that was planned to be radiated. The external drainage- catheter was wrapped and fixed to the skin, or was imbedded under the skin. Results Of the 38 patients with malignant biliary obstruction, successful PTIBS combined with radioactive seed implantation was accomplished in 36 patients. After the treatment, the serum bilirubin level fell to normal or near normal range in all patients （P 〈 0.05）. No obvious side effects were observed. Conclusion For the treatment of malignant biliary obstruction, percutaneous transhepatic insertion of biliary stent combined with radioactive 125I seed - strip implantation is a safe and effective method.

关 键 词：黄疸 梗阻 125I粒子 内放射治疗 支架 

分 类 号：R735[医药卫生—肿瘤]