胆胰恶性肿瘤放疗前胆道引流的方式

Modality of Biliary Duct Drainage before Radiotherapy for Biliary or Pancreatic Malignant Tumors

目的:选择合理、有效的胆道引流方式,辅助胆胰恶性肿瘤的放射治疗,以延长中晚期病人的生存期,减轻其痛苦。方法:对852例胆胰恶性肿瘤伴阻塞性黄疸病人,分别经内镜放置胆道塑料、金属支架引流,鼻胆管持续负压引流,或经超声介入经皮肝穿刺肝内胆管置管引流,48h后,实施CT定位下γ-刀治疗。结果:胆胰恶性肿瘤放疗加胆道引流,优良率89.1%。鼻胆管组和经皮肝穿组疗效优于塑料支架组和金属支架组(P<0.05)。结论:病人"黄疸"越深,年龄越大,引流意义越大;病情越重,引流越早越好。放疗前的介入引流,以简便、微创、安全、尽快缓解病情、减轻病人痛苦为治疗原则。

Objective To choose rational and effective methods of biliary drainage aid radiation therapy for biliary and pancreatic malignant tumor to improve patients’ survival and reduce the suffering. Methods Eight hundred and 52 patients with biliary or pancreatic malignant tumors were given endoscopic placement of biliary plastic or metal stent drainage, or naso-biliary drainage with continuous negative pressure drainage duct or ultrasound intervention percutaneous intrahepatic bile duct drainage. Drainage after 48 hours, Gamma Rays treatment could be stated. Results Excellent and good result of biliary or pancreatic malignant tumor were obtained up to 89% with radiotherapy and bilary drainage. The result of metal biliary stenting group was significantly better than that of the other groups（P0.05）. Conclusion Biliary drainage was more important in case of severe jaundice and in elderly patients. In severe conditions simple and minimally invasive drainage should be done as early as possible.