胆道双支架联合125I粒子腔内照射治疗恶性肝门部胆道梗阻的疗效分析  

Biliary dual stent combined with I particles intracavitary irradiation for the treatment of malignant hilar biliary obstruction:analysis of curative effect

作　　者：朱超[1] 刘会春[1] 胡小四 庞青 陈邦邦 李传涛 ZHU Chao;LIU Huichun;HU Xiaosi;PANG Qing;CHEN Bangbang;LI Chuantao(Department of Hepatobiliary Surgery,First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui Province 233004,China)

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：《介入放射学杂志》2020年第11期1100-1104,共5页Journal of Interventional Radiology

基　　金：安徽省科技攻关项目(1501041155);蚌埠医学院研究生科研创新计划项目(Byycxz1924)。

摘　　要：目的探索胆道双支架和胆道双支架联合125I粒子腔内照射治疗恶性肝门部胆道梗阻(MHBO)的治疗效果差异。方法选取2013年1月至2019年1月行胆道双支架(对照组)或胆道双支架联合125I粒子腔内照射(观察组)治疗的42例MHBO患者,分析两组患者肝功能改善情况,术后胆道再梗阻,术后并发症及生存时间等差异。结果与术前相比,两组患者术后1、3、6个月总胆红素、直接胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶水平均明显降低(P均<0.05);对照组术后3、6个月和观察组术后1、3、6月白蛋白明显升高(P均<0.05)。观察组较对照组降低了胆道再梗阻发生率(P<0.05)。两组患者术后并发症发生率差异无统计学意义(P>0.05)。对照组患者中位生存时间为7.0个月,1年生存率为20.0%,观察组患者中位生存时间为10.0个月,1年生存率为40.9%。累积生存率差异有统计学意义(P<0.05)。结论相比于胆道双支架,胆道双支架联合125I粒子腔内照射治疗MHBO,在相同减黄效果的同时,可降低术后胆道再梗阻发生率,延长患者生存时间,且不增加术后并发症的风险。Objective To compare the curative effect of biliary dual stent with that of biliary dual stent combined with125I particles intracavitary irradiation in treating malignant hilar biliary obstruction(MHBO).Methods A total of 42 patients with MHBO,who were admitted to authors’hospital during the period from January 2013 to January 2019 to receive treatment,were collected.Of the 42 patients,20 received biliary dual stent treatment(control group)and 22 received biliary dual stent combined with125I particles intracavitary irradiation treatment(observation group).The liver function improvement,postoperative biliary re-obstruction,postoperative complications and survival time were compared between the two groups.Results Compared with preoperative data,the 1-,3-and 6-month postoperative levels of bilirubin,direct bilirubin,alanine aminotransferase,aspartate aminotransferase and alkaline phosphatase were significantly decreased in both groups(P<0.05 in all),the postoperative albumin level increased significantly after 3-and6-month of control group and 1-,3-and 6-month of observation group(P<0.05 in all).The incidence of biliary re-obstruction in the observation group was lower than that in the control group(P<0.05).No statistically significant difference in the incidence of postoperative complications existed between the two groups(P>0.05).The median survival time and one-year survival rate in the control group were 7.0 months and 20.0%respectively,which in the observation group were 10.0 months and 40.9%respectively.The difference in the cumulative survival rate between the two groups was statistically significant(P<0.05).Conclusion Compared with biliary dual stent treatment for MHBO,the biliary dual stent combined with125I particles intracavitary irradiation treatment can reduce the incidence of biliary re-obstruction,prolong patients’survival time,and achieve the same effect of reducing jaundice,while it will not increase the risk of postoperative complications.

关 键 词：金属胆道支架 125I粒子 胆道腔内放射治疗 恶性肝门胆道梗阻 

分 类 号：R735.8[医药卫生—肿瘤]