TACE或三维放疗防治恶性胆道梗阻支架阻塞的临床价值  

TACE or three-dimensional radiotherapy for patients of malignant biliary obstruction after stent placement

作　　者：虞希祥[1] 罗雅[1] 乔彬彬[2] 王舒婷[2] 施振静[1] 施昌盛[1] 朱国庆[1] 郑冰汝 王玉斌[3] 盂庆建 

机构地区：[1]温州医科大学附属第三医院介入科,浙江省瑞安325200 [2]温州医科大学研究生院 [3]温州医科大学附属第三医院肿瘤放疗科,浙江省瑞安325200 [4]山东省兖矿集团总医院介入科

出　　处：《中华普通外科杂志》2014年第11期864-867,共4页Chinese Journal of General Surgery

基　　金：浙江省温州市科技计划基金资助项目（Y20110147）

摘　　要：目的 探讨肝动脉化疗栓塞术（transcatheter arterial chemoembolization,TACE）或三维适形放疗（three dimensional comformal radiotherapy,3D-CRT）防治恶性胆道梗阻支架置入术后再阻塞的临床意义.方法 45例胆道恶性梗阻患者随机分为3组（各15例）.A组为TACE组,采用经皮肝穿刺胆道内外引流（percutaneous transhepatic cholangial drainage,PTCD）及支架置入加TACE治疗;B组为放疗组,采用PTCD及支架置入加3D-CRT;C组为对照组,仅采用PTCD及支架置入治疗.支架置入术后1、2、3、4个月分别经引流道行胆管和支架内活检术,针对阻塞原因给予相应处理,肉芽组织增生采用更换引流管或再次置入支架;肿瘤生长采用再次TACE或放疗.结果 A组患者平均维持通畅时间102 d;支架内肉芽组织增生4例,肿瘤生长2例.B组平均维持通畅时间94 d;支架内肉芽组织增生2例,肿瘤生长1例.C组平均维持通畅时间51d;支架内肉芽组织增生3例,肿瘤生长6例.A组、B组和C组3个月生存率分别为93％、87％和60％;6个月生存率分别为60％、47％和20％;9个月生存率分别为20％、13％和0.结论 恶性胆道梗阻支架置入术后再阻塞,早期与肌成纤维细胞活性增强相关,后期与肿瘤生长相关,TACE或3D-CRT能有效防治支架内肿瘤生长所致的再阻塞.Objective To evaluate transcatheter arterial chemoembalization （TACE）and/or threedimentional radiotherapy for the prevention of stent restenosis in patients of malignant biliary obstruction.Methods In this series,45 cases of malignant biliary obstruction after stent placement were randomly divided into three groups,15 cases in each group.Group A patients received TACE management,patients in group B were treated with three-dimensional conformal radiotherapy,patients in group C received supportive therapy.On 1,2,3,4 months after stent placement,intra-stent biopsy was performed,obstruction was managed by stent replacement.Results Time of stent patence was 102,94 and 51 days respectively in group A,B,and C.3 months survival rate was 93%,87% and 60% respectively; 6 months survival rate was 60%,47% and 20% respectively; 9 months survival rate was 20%,13% and 0 respectively.Conclusions For malignant biliary obstruction after biliary tract stenting,TACE and or 3D radiation therapy can effectively prevent stent restenosis caused by tumor growth.

关 键 词：胆管 肝内 抗肿瘤联合化疗方案 恶性梗阻 支架术后再阻塞 放射学 介入性 

分 类 号：R657.4[医药卫生—外科学]