胆道支架合并125I粒子治疗胰头癌

Combination treatment with biliary stent and 125I for pancreatic head carcinoma

目的探讨胆道支架合并125I粒子治疗不能切除的胰头癌的方法和疗效。方法 2007年9月~2011年9月,22例合并黄疸不能切除的胰头癌患者,16例行十二指肠镜ER CP胆道支架植入,6例行B超引导的PTCD及经PTC通道胆道支架植入术,支架植入均在X光透视下进行;18例在CT引导下行胰头癌穿刺植入125I粒子,4例在B超引导下行粒子植入。125I粒子活度0.6 mCi,数目：9~57粒。术后检测胆红素、肿瘤相关标记物等;随访观察患者生存状况和生存时间。结果总胆红素和ALT较术前显著下降（均P〈0.05）。CA19-9治疗后明显下降（P〈0.05）。肿瘤完全缓解2例（9.09%）,部分缓解10例（45.47%）,无变化8例（36.36%）,恶化2例（9.09%）,总有效12例（54.55%）。临床受益反应明显。全组中位生存期为9.5个月,其中Ⅱ和Ⅲ期患者中位生存期为13.4个月。并发症有腹腔少量出血（2例）、轻度胰漏（2例）、轻中度发热（3例）和穿刺部位疼痛,均经非手术治疗消失或好转。结论胆道支架合并125I粒子是治疗不能手术切除的胰头癌的有效手段。

【Objective】 To study and observe the effect of combination treatment with biliary stent and 125I on pancreatic head carcinoma.【Methods】 Twenty-two cases of pancreatic head carcinoma complicating obstructive jaundice and can not be operated were brought into this study.Biliary stent was planted in all cases,which in 16 cases was by duodenoscope and in 6 cases was by B-ultrasonic-guided PTCD.After jaundice reduced,125I seed was planted into tumor guided by CT（18 cases） or B-ultrasonic（4 cases）.Activity of 125I is 0.6mCi,and amount is 9～57.Total bilirubin,alanine aminotransferase and tumor markers was checked pre-and post-operatively.Survival condition and survival time was accounted.【Results】 Total bilirubin,alanine aminotransferase and CA19-9 was reduced post-operatively more significantly than these pre-operatively（P value was all less than 0.05）.Tumors in 2 of all cases were complete remission（CR）,10 partial remissions（PR）,8 stable diseases（SD） and 2 progression diseases（PD）.Clinical benefit response was remarkable.Median survival time of all was 9.5 months,and of phase II and III was 13.4 months.The complications were a small amount of bleeding（2 cases）,mild pancreatic juice leaking,low-or medium-grade fever and pain in the puncture,which disappeared or improved by non-operative treatment.【Conclusion】 Combination treatment with biliary stent and 125I is a highly effective means for pancreatic head carcinoma can not be resected.