^(125)I粒子条联合胆道金属支架植入术治疗恶性肝门区胆管梗阻

Implantation of Iodine-125 seed strand combined with biliary metallic stent in treatment of malignant hilar biliary obstruction

目的探讨^(125)I粒子条联合胆道金属支架植入术治疗恶性肝门区胆管梗阻的有效性及安全性。方法胆管梗阻患者38例,分为粒子组(n=18)和对照组(n=20)。粒子组接受^(125)I放射性粒子条联合胆道金属支架植入术,对照组接受单纯胆道金属支架植入术。观察治疗前后患者肝功能改善、血胆红素下降及手术相关并发症情况,比较2组胆道支架通畅时间及患者总生存时间差异。结果 2组术后1个月血清总胆红素、直接胆红素、碱性磷酸酶、谷氨酰转移酶、谷草转氨酶及谷丙转氨酶水平较术前均有显著性下降(P均<0.05)。粒子组与对照组支架通畅时间分别为(192.94±28.59)天与(121.40±15.39)天。2组支架通畅率比较差异有统计学意义(χ~2=3.907,P=0.048);生存时间分别为(201.83±27.50)天与(142.25±15.46)天。2组生存率比较差异无统计学意义(χ~2=2.760,P=0.097)。并发症主要包括胆管炎、无症状淀粉酶升高、少量胆道出血等,2组间差异均无统计学意义(P均>0.05)。结论 ^(125)I粒子条联合胆道金属支架植入术治疗恶性肝门区胆管梗阻安全、有效,可显著提高支架通畅率。

Objective To explore the effectiveness and safety of percutaneous biliary stenting combined with implantation of 125-iodine seed strand in treatment of unresectable malignant hilar biliary obstruction.Methods Totally 38 patients with unresectable malignant hilar biliary obstruction were enrolled and divided into 125-iodine group(n=18)and control group(n=20).Patients in 125-iodine group underwent percutaneous placement with self-expandable metallic stent(SEMS)combined with implantation of 125-iodine seed strand,while in control group underwent SEMS only.Patient's liver function,serum bilirubin and complications before and after treatment were observed,and biliary stent patency time and overall survival time were compared between 2 groups.Results The post-operation levels of total serin bilirubin,direct bilirubin,alkaline phosphatase,gamma-glutamyl peptidase,glutamic oxalacetic transaminase and glutamic pyruvic transaminase were significantly lower in than pre-operation(all P<0.05).The biliary stent patency time was(192.94±28.59)days in 125-iodine group and(121.40±15.39)days in control group.The difference of biliary stent patency rate was statistically significant between the 2 groups(χ2=3.907,P=0.048).The overall survival was(201.83±27.50)days in 125-iodine group and(142.25±15.46)days in control group.The was no significant difference of survival rate between the 2 groups(χ2=2.760,P=0.097).The common complications were cholangitis,asymptomatic amylase elevation,and a small amount of biliary tract bleeding.The incidence of complications were not different between the 2 groups(all P>0.05).Conclusion 125-iodine strand implantation combined with SEMS placement was safe and effective in treatment for unresectable malignant hilar biliary obstruction,which might prolong stent patency rate in these patients.