胆道支架联合125I粒子条治疗恶性梗阻性黄疸  

Biliary stenting combined with 125I seed implantation intracavitary irradiation for the treatment of malignant obstructive jaundice

作　　者：姚红响[1] 陈根生[1] 叶冠雄[1] 徐胜前[1] 吴成军[1] 秦勇[1] 潘德标[1] 曾群[1] 陈烨[1] 张鹏朝 

机构地区：[1]浙江丽水丽水市人民医院介入科,323000

出　　处：《介入放射学杂志》2014年第10期893-896,共4页Journal of Interventional Radiology

基　　金：淅江省丽水市科技局科研项目(编号:2012ZC039)

摘　　要：目的：探讨通过胆道支架联合125I粒子条植入腔内照射治疗恶性梗阻性黄疸技术方法、安全性及临床价值。方法对36例恶性阻塞性黄疸患者，先行PTCD引流后，二期采用125I粒子条联合胆道支架植入腔内照射治疗恶性梗阻性黄疸。结果手术过程支架及粒子条移位2例，经胆道活检钳复位，技术成功率100%，黄疸缓解率100%；所有患者术后随访1-23个月，未发生放射性泄漏、放射性肠炎等并发症；支架内未见明显肿瘤复发导致再次梗阻征象，但部分患者（25%）由于支架网孔处内膜增生或胆道内结石形成导致肝内胆管轻度扩张；其中位生存时间10.9个月。结论125I粒子条联合胆道支架植入腔内照射治疗恶性梗阻性黄疸手术安全可靠，疗效肯定，术后能延长支架通畅时间，有望延长患者生存期。Objective To discuss the method, safety and clinical value of biliary stenting combined with 125I seed implantation intracavitary irradiation in treating malignant obstructive jaundice. Methods A total of 36 patients with malignant obstructive jaundice were enrolled in this study. PTCD was carried out in all patients, which was followed by biliary stenting combined with 125I seed implantation intracavitary irradiation treatment. The results were analyzed. Results During the interventional management, displacement of the stent and 125I seeds were observed in two cases, and the displaced stent and 125I seeds were replaced to the right position with the help of biliary biopsy forceps. The technical success rate was 100%, and the remission rate of the jaundice was 100%. All the patients were followed up for 1-23 months. No radioactive particles leaking or complications such as radiation enteritis occurred. No in-stent obstruction due to tumor recurrence was observed although slight dilatation of intrahepatic bile duct was detected in 25%of patients, which was resulted from intimal hyperplasia at the stent mesh and/or biliary stone formation. The median survival time was 10.9 months. Conclusion For the treatment of malignant obstructive jaundice, biliary stenting combined with 125I seed implantation intracavitary irradiation is safe, reliable and effective. This technique can prolong stent patency time as well as the patient’s survival time.

关 键 词：胆道支架 125I粒子 腔内照射 恶性梗阻性黄疸 

分 类 号：R735.7[医药卫生—肿瘤]