经皮胆道支架联合近距内放疗治疗不能手术切除的肝门胆管癌  

Percutaneous biliary stenting combined with brachytherapy for the treatment of unresectable Klatskin's tumor

作　　者：施东华[1] 翟博[1] 沈加林[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肿瘤介入科,200127

出　　处：《介入放射学杂志》2017年第3期243-248,共6页Journal of Interventional Radiology

摘　　要：目的探讨经皮胆道支架联合近距内放疗治疗不能手术切除的肝门胆管癌的可行性、安全性和有效性,以及联合治疗对患者黄疸复发和生存期的影响。方法对2014年2月—2015年12月上海仁济医院肿瘤介入科收治的21例不能手术切除而接受经皮胆道支架联合近距内放疗的肝门胆管癌患者及该院同期单纯胆道引流或金属裸支架植入的患者28例进行回顾性分析。观察手术成功率、退黄效果及术后并发症发生率,比较两组患者生存期和黄疸复发时间的差异。结果 21例联合治疗患者共植入金属裸支架32枚,放射性125I粒子580颗,手术成功率100%,治疗有效率85.7%,术后早期并发症发生率9.5%,无手术相关死亡发生。联合治疗组患者术后中位黄疸复发时间为344 d而单纯胆道引流或金属裸支架植入患者的中位黄疸复发时间为193 d(P=0.035)。联合治疗组患者中位生存期387 d明显长于单纯胆道引流或金属裸支架植入患者的256 d(P=0.022)。结论经皮胆道支架联合近距离内放疗作为不能手术切除的肝门胆管癌患者的姑息治疗方案安全有效可行,联合治疗能够推迟肝门胆管癌患者的黄疸复发及延长生存期。Objective To investigate the feasibility, safety and effectiveness of percutaneous biliary stenting combined with brachytberapy in treating unresectable Klatskin＇s tumor, and to discuss the effect of this combination treatment on jaundice recurrence and survival. Methods The clinical data of 21 patients with unreseetable Klatskin＇s tumor （combination group）, who were admitted to Department of Interventional Oncology, Shanghai Renji Hospital during the period from February 2014 to December 2015 to receive percutaneous biliary stenting combined with brachytherapy, were retrospectively analyzed; and other 28 patients, who were admitted to hospital to receive pure biliary drainage or bare metal stent implantation during the same period, were collected and used as the control group. The success rate of operation, the effect of reducing jaundice and postoperative complication rate were calculated, and the differences in survival time and jaundice recurrence time were compared between the two groups. Results A total of 32 bare metal stent sand 580 125I seeds were implanted in the 21 patients of the combination group, the success rate of operation was 100%, and the effective rate of treatment was 85.7%. The early postoperative complication rate was 9.5%, and no procedure-related death occurred. The median jaundice recurrence time in the combination group was 344 days, while it was 193 days in the control group （P=0.035）. The median survival time in the combination group was 387 days, which was strikingly longer than 256 days in the control group （P=0.022）. Conclusion For the treatment of unresectable Klatskin＇s tumor, percutaneous biliary stentingcombined with brachytherapy, used as a palliative therapeutic regimen, is safe, effective and feasible, it can delay the recurrence of jaundice and prolong the survival time.

关 键 词：肝门胆管癌 梗阻性黄疸 胆道支架 近距放疗 125I粒子 

分 类 号：R735.8[医药卫生—肿瘤]