肝门部恶性梗阻性黄疸应用多支架联合^(125)I放射性粒子腔内照射治疗的效果观察  

Effect observation of multiple stents combined with ^(125)I radioactive particles intracavitary irradiation for malignant obstructive jaundice in the hilar region

作　　者：孙勋 邢斌 高佳 吴兆瑞 刘艳丽 孙继雷 成静静 刘静 SUN Xun;XING Bin;GAO Jia(Dongying Second People's Hospital,Dongying 257000,China)

机构地区：[1]东营市第二人民医院,257000

出　　处：《中国实用医药》2024年第12期9-12,共4页China Practical Medicine

摘　　要：目的 分析肝门部恶性梗阻性黄疸(MOJ)应用多支架联合^(125)I放射性粒子腔内照射治疗的临床效果。方法 30例肝门部MOJ患者为研究对象,所有患者均接受多支架联合^(125)I放射性粒子腔内照射治疗。分析患者手术一般情况、术中并发症发生率;对比患者手术前后总胆红素水平、恶性梗阻性黄疸患者特异性条目池(QLQ-MOJ11)评分及术后不同时间总胆红素缓解率、黄疸缓解率、生存率、胆道再次梗阻发生率。结果 30例患者均一次性顺利置入支架,共置入支架55枚,术后影像学检查明确胆道狭窄处得以改善,术后患者黄疸逐渐消退,肝功能逐渐好转。患者术后1、3个月总胆红素水平分别为(39.35±13.96)、(21.30±10.63)μmol/L,均显著低于术前的(144.62±63.73)μmol/L(P<0.05);患者术后3个月总胆红素水平显著低于术后1个月(P<0.05)。患者术后3个月总胆红素、黄疸缓解率分别为100.00%、100.00%,高于术后1个月的76.67%、73.33%(P<0.05)。30例患者均未出现大出血、休克、心脏血管意外等并发症。患者术后6、12、16个月生存率及胆道再次梗阻发生率对比差异均无统计学意义(P>0.05)。患者术后3个月黄疸、瘙痒、消瘦、消化异常的QLQ-MOJ11评分分别为(26.35±3.85)、(27.42±5.63)、(43.67±6.93)、(22.63±3.27)分,均低于术前的(35.32±4.23)、(36.18±6.72)、(53.93±6.67)、(30.41±5.71)分(P<0.05)。结论 多支架联合^(125)I放射性粒子腔内照射治疗肝门部MOJ能显著提升其临床效果,改善总胆红素水平,降低胆道再梗阻率,提升患者生活质量,其安全性也较高,具有较高的应用价值。Objective To analyze the clinical effect of multiple stents combined with ^(125)I radioactive particles intracavitary irradiation for malignant obstructive jaundice(MOJ)in the hilar region.Methods A total of 30 patients with malignant obstructive jaundice in the hilar region were included in the study.All patients received combined treatment of multiple stents and ^(125)I radioactive particles intracavitary irradiation.The general operation conditions and the incidence of intraoperative complications of patients were analyzed.The total bilirubin level and quality of life questionnaire of malignant obstructive jaundice 11(QLQ-MOJ11)score before and after surgery,total bilirubin remission rate,jaundice remission rate,survival rate,and incidence of biliary re-obstruction at different time after surgery were compared.Results All 30 patients had single-time stent placement,and a total of 55 stents were inserted in patients.Postoperative imaging examination clearly showed that the biliary stenosis was improved,and the jaundice of the patients gradually subsided and the liver function gradually improved after surgery.The total bilirubin levels at 1 and 3 months after surgery were(39.35±13.96)and(21.30±10.63)μmol/L,which were significantly lower than(144.62±63.73)μmol/L before surgery(P<0.05).The total bilirubin level at 3 months after surgery was significantly lower than that at 1 month after surgery(P<0.05).The remission rates of total bilirubin and jaundice were 100.00%and 100.00%at 3 months after surgery,which were higher than 76.67%and 73.33%at 1 month after surgery(P<0.05).None of the 30 patients had complications such as massive hemorrhage,shock,and cardiovascular accidents.There was no significant difference in the survival rate and the incidence of biliary obstruction at 6,12 and 16 months after surgery(P>0.05).The QLQ-MOJ11 scores of jaundice,pruritus,emaciation and digestive disorders at 3 months after surgery were(26.35±3.85),(27.42±5.63),(43.67±6.93)and(22.63±3.27)points,which were lower than(35.32�

关 键 词：肝门部 恶性梗阻性黄疸 多支架 ^(125)I放射性粒子 腔内照射 

分 类 号：R735[医药卫生—肿瘤] R730.55[医药卫生—临床医学]