胆道支架联合引流管置入^(125)I粒子条治疗恶性梗阻性黄疸

Biliary stent implantation combined with ^(125)I seeds strip implantation in percutaneous drainage tube for treating malignant obstructive jaundice

目的观察胆道支架联合引流管置入^(125)I粒子条治疗恶性梗阻性黄疸(MOJ)的价值。方法回顾性分析35例接受胆道支架植入联合引流管置入^(125)I粒子条的MOJ患者,观察手术效果、术后支架通畅时长及患者生存期。结果35例均成功完成治疗。术前总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(GPT)及谷草转氨酶(GOT)与术后1周及1个月差异均有统计学意义(P均<0.05)。术后16例显著有效、19例有效;高、低位梗阻总显著有效率分别为38.10%(8/21)和57.14%(8/14),差异无统计学意义(χ^(2)=1.228,P=0.268)。截至随访日共对26例更换粒子条,其中19例更换1次、7例更换2次,均未发生放射剂量累积过高而致胆管破溃及穿孔等情况。35例术后支架通畅时长(7.83±2.02)个月,患者生存期(14.06±4.78)个月。结论胆道支架植入联合引流管置入^(125)I粒子条用于胆道受压及狭窄均不严重MOJ患者疗效较佳。

Objective To observe the value of biliary stent implantation combined with ^(125)I seeds strip implantation in percutaneous drainage tube for treating malignant obstructive jaundice(MOJ).Methods Data of 35 MOJ patients who underwent biliary stent implantation combined with ^(125)I seeds strip implantation in percutaneous drainage tube were retrospectively analyzed.The therapeutic effect,postoperative stent patency time and patient survival time were observed.Results The treatments were successfully completed in all 35 cases.There were significant differences of total bilirubin(TBIL),direct bilirubin(DBIL),glutamic-pyruvic transaminase(GPT)and glutamic-oxaloacetic transaminase(GOT)before operation,1 week and 1 month after operation(all P<0.05).After treatments,markedly effective was observed in 16 cases,while effective was observed in 19 cases,the markedly effective rate of patients with high and low obstruction was 38.10%(8/21)and 57.14%(8/14),respectively,and no significant difference was found(χ^(2)=1.228,P=0.268).Up till the ending of following-up,^(125)I seeds strips were replaced in 26 cases,including 19 cases once and 7 cases twice,no bile duct rupture nor perforation caused by excessive radiation dose accumulation occurred.The postoperative stent patency time of all 35 cases was(7.83±2.02)months,and patients survival time was(14.06±4.78)months.Conclusion Biliary stent implantation combined with ^(125)I seeds strip implantation in percutaneous drainage tube might achieve good the curative effect in MOJ patients without serious bile duct compression nor stenosis.