胆管癌患者腔内综合治疗与姑息性手术疗效比较  

Comparison of the therapeutic efficacy of combined intracavitary therapy with palliative surgery in patients with extrahepatic ductal cholangiocarcinoma

作　　者：黄伟[1] 刘会春[1] 王远鹏[1] 许文青[1] 李宗狂[1] 鲁贻民[1] 金浩[1] 周磊[1] 满忠然[1] 王勇[1] 

机构地区：[1]蚌埠医学院第一附属医院肝胆外科,安徽233004

出　　处：《中华肝胆外科杂志》2017年第6期389-394,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：安徽省科技攻关项目（1501041155）

摘　　要：目的探讨经皮胆道支架置入联合^125I粒子腔内照射与姑息性手术治疗胆管癌的疗效差异。方法选取蚌埠医学院第一附属医院2012年1月至2015年12月收治的142例胆管癌患者的临床资料，经皮胆道支架置入联合^125I粒子腔内照射（支架粒子组）80例；姑息性手术（手术组）62例，其中包括R1切除17例，R2切除26例，胆肠内引流19例。分析比较两组患者治疗前后黄疸水平、肝功能、生存时间、住院时间和住院费用等差异。结果两组术后短时间内均可有效减轻黄疸，术后1月、3月和6月肝功能较术前明显改善，差异有统计学意义（P〈0．05）。支架粒子组患者的平均住院时间为（16．5±5．0）d，手术组为（25．5±10．5）d，两组差异有统计学意义（P〈0．05）。支架粒子组患者的平均住院费用为（39622．0±7666．4）元，手术组为（59562．0±24218．2）元，两组差异有统计学意义（P〈0．05）。支架粒子组患者平均生存时间为（12．2±5．1）个月，手术组为（12．7±7．5）个月，两组差异无统计学意义（P〉0．05）。结论对于不能行根治手术的胆管癌患者，经皮胆道支架置入联合^125I粒子腔内照射治疗，能够有效减黄、改善肝功能、缩短住院时间及减少住院费用，与姑息性手术相比具有创伤小、易于操作、安全有效及可多次治疗等优点，尤其适合年龄大、身体状况差的患者。Objective To compare the therapeutic efficacy of combined biliary stent and 125I seed intracavity irradiation with palliative surgery in the treatment of extrahepatic ductal cholangiocarcinoma. Methods A prospective analysis was conducted on 142 patients with cholangiocarcinoma who were treated in The First Affiliated Hospital of Bengbu Medical College from January 2012 to December 2015. There were 80 patients who underwent percutaneous biliary metal stenting combined with 125I particles implantation （the stenting-particle group） and 62 patients who were treated by palliative biliary drainage （the surgical group）. The surgical group included R1 resection in 17 patients, R2 resection in 26 patients and biliary enteric drainage in 19 patients）. The levels of jaundice, liver function, survival time, hospitalization time and hospitalization cost before and after therapy were analyzed. Results Jaundice was effectively alleviated in the two groups after a short period. The liver function in the 2 groups improved significantly at 1,3 and 6 months when compared with that before operation, （ P 〈 0.05 ）. The average hospitalization time of the stenting-partiele group and the surgery group were （ 16. 5 ± 5.0） days and （25. 5 ±10. 5 ） days, respectively, （ P 〈0. 01）. The average hospitalization cost of the stenting-particle group and the surgery group were （ 39 622.0± 7 666.4） yuan and （59 562.0 ±24 218.2） yuan, respectively, （ P 〈 0.05 ）. The average survival time of the stenting-particle group and the surgery group were （ 12. 2± 5.1 ） months and （ 12. 69 ± 7.46） months, respectively, and the difference was not significantly different （P 〉 0.05）. Conclusions For patients with extrahepatic ductal cholangiocarcinoma who were not suitable for radical surgery, percutaneous biliary stenting combined with 125I seed brachytherapy effectively reduced jaundice, improved liver function, shortened average length of hospital stay and reduced average cost of hospitalization

关 键 词：胆管癌 姑息性手术 胆道支架 ^125I粒子 梗阻性黄疸 

分 类 号：R735.8[医药卫生—肿瘤]