表阿霉素在恶性梗阻性黄疸治疗中的应用

Epirubicin in the treatment of malignant obstructive jaundice

目的探讨表阿霉素治疗恶性梗阻性黄疸(MOJ)的安全性和可行性。方法39例 MOJ患者接受胆道支架置放术或经皮穿肝胆道引流术(PTBD)后,血清胆红素未降至正常水平即接受动脉化疗栓塞术(TACE)。TACE方案:法玛新30 mg／m2和超液化碘油混合成乳剂。参照WHO抗癌药物毒性分级标准观察毒性反应,Child-Push分级观察肝脏损害。随访患者黄疸复发时间和生存期。结果39例MOJ患者TACE术前血清总胆红素浓度为52．1-91．4μmol／L,中位值72．7μmol／L。表阿霉素总量40-60 mg,中位值55．0 mg,超液化碘油2-25 ml。白细胞计数下降:Ⅰ度41．0％,Ⅱ度35．9％,Ⅲ-Ⅳ度15．4％;恶心呕吐:Ⅲ-Ⅳ度100％。肝脏Child-Pugh分级:8例由A级升至 B级,1例由A级升至C级,3例由B级升至C级。全部患者未出现心脏毒性。39例患者的生存期为 2-72个月,中位值6．0个月。19例黄疸复发,复发率48．7％,黄疸复发时间2-20个月,中位值9．0 个月。结论 MOJ患者行有效引流后,即使胆红素未降至正常水平,用30 mg／m2表阿霉素和超液化碘油乳剂进行单纯化疗栓塞治疗原发病灶是安全和有效的。

Objective To evaluate the safety and efficiency of epirubicin in the treatment of malignant obstructive jaundice （MOJ）. Methods Thirty-nine patients with diagnosis of MOJ, whose serum total bilirubin （TB） had not dropped to normal level after stent placement or percutaneous transhepatic biliary drainage, received trans-arterial chemoembolization （TACE）. During TACE, epirubicin emulsion containing pharmorubicin at dose of 30 mg/m^2 was used. The toxicity and hepatic injury was observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion, respectively. The time of jaundice recurrence and survival were also observed during follow-up. Results Median total serum bilirubin in 39 patients was 72.7 μmol/L （range： 52.1 -91.4 μmol/L） before TACE. The dose of pharmorubicin was 40 - 60 mg with a median of 55.0 mg and the amount of lipiodol was 2 - 25 ml. Decrease in white blood cell count was observed ： grade Ⅰ in 41.0% of patients, grade Ⅱ in 35.9% and grade Ⅲ - Ⅳ in 15.4%. Grade Ⅲ- Ⅳ nausea and vomiting developed in 100% of the patients. Hepatic injury became aggravated in 8 from A to B class patients, in one from A to C class, and in 3 from B to C class according to Child-Pugh classification criterion. No cardiac toxicity was observed in this series. The median survival time was 6.0 months with a range of 2 to 72 months. Jaundice recurred in 19 patients （48.7%） with a medium jaundice recurrence time of 9.0 months （range： 2 -20 months）. Conclusion Epirubicin-lipiodol emulsion at a dose of 30 mg/m^2 is safe and efficient in the management of patients with malignant obstructive jaundice with total serum bilirubin between 51 and 100 μmol/L after biliary drainage.