经内镜胆管支架或鼻胆管置放结合γ刀治疗胆管恶性梗阻的临床观察

Clinical observation of malignant billary obstruction treated by endoscopic biliary stents or naso-biliary tube placement combined with gamma-knife therapy

目的探讨经十二指肠镜胆管支架或鼻胆管置放与γ刀结合治疗胆管恶性梗阻性疾病的疗效。方法29例胆管恶性梗阻患者中20例被放置塑料支架，6例放置鼻胆管；均行γ刀治疗10～12次／疗程，总剂量为40～50Gy。结果插管成功率89．7％。并发症3例（10．3％），其中急性胰腺炎2例，急性胆管炎1例。血清胆红素术前290μmol／L，术后1周下降到101μmol／L。治疗3,6个月存活率分别迭96％及80％。结论经内镜胆管支架或鼻胆管置放结合γ刀治疗胆管恶性梗阻性疾病安全、有效。

Objective To explore the therapeutic effect of endoscopic biliary stents or naso-biliary tube placement combined with gamma-knife therapy in malignant biliary obstructions. Methods The 29 patients suffering from malignant biliary obstruction were treated, 20 of whom were implanted with plastic stents and 6 were with nasobiliary tubes. All patients were radiated by gamma-knife therapy, 10-12 times a period of treatment with 40-50 Gy in general dosage. Results The success rate of intubation was 89.7%. 3 eases developed complications （ 10.3% ） , including 2 acute panereatitis and 1 acute eholangitis. Serum bilirubin decreased from 290 μmol/L to 101μmol/L in 1 week. Survival rates after treatment were 96% and 80% in 3 months and 6 months, respectively. Conclusion Endoscopic biliary stents or naso-biliary tube placement combined with gamma-knife therapy is safe and effective in treating malignant biliary obstruction.