腔内近距离放疗联合及支架植入治疗恶性胆道梗阻

Intraluminal brachytherapy combined with stent placement for the treatment of malignant biliary obstruction

目的评价经皮植入125I粒子条及支架治疗恶性胆道梗阻的安全性及疗效。方法对2009年6月至2013年6月,在上海中山医院接受介入治疗的68例恶性胆道梗阻患者的资料进行回顾性分析,其中41例在胆道梗阻段同时植入支架和125I粒子条(联合治疗组),27例仅植入支架(传统治疗组),对两组患者的生存期、至黄疸进展时间及手术相关不良事件发生率进行比较。结果所有125I粒子条和支架植入均获成功。传统支架组和联合支架组术后7、14 d血清胆红素水平组间差异有统计学意义(P<0.05);联合支架组术后未发生明显骨髓抑制;单纯支架组和联合支架组中位生存期分别为123和215 d,差异有统计学意义(P<0.05)。结论腔内近程放疗联合支架植入治疗恶性胆道梗阻安全,疗效较单纯植入支架明显。

Objective To evaluate the safety and effectiveness of intraluminal implantation of^125 I seeds strand combined with stent placement in treating malignant biliary obstruction.Methods During the period from June 2009 to June 2013,a total of 68 patients with malignant biliary obstruction were admitted to Shanghai Zhongshan Hospital.Interventional management was carried out in all patients.The clinical data were retrospectively analyzed.Of the 68 patients,intraluminal implantation of125 I seeds strand combined with simultaneous stent placement was performed in 41（combination therapy group） and only stent placement was employed in 27（conventional therapy group）.The survival time,the improvement of obstructive jaundice,recurrence of jaundice and procedure-related adverse events were recorded,and the results were compared between the two groups.Results Implantation of^125 I seeds strand and stent placement were successfully accomplished in all patients.Statistically significant differences in serum bilirubin levels,which were separately determined at 7 days and 14 days after the treatment,existed between the two groups（P〈0.05）.No obvious marrow depression was observed in the combination therapy group.The median survival time of the conventional therapy group and the combination therapy group was 123 days and 215 days respectively.The difference was statistically significant（P〈0.05）.Conclusion For the treatment of malignant biliary obstruction,combination use of intraluminal brachytherapy and stent placement is clinically more safe and effective than conventional pure stent placement therapy.