经皮胆道支架联合支架内外粒子植入治疗胰头癌伴胆道梗阻

Percutaneous Biliary Stenting Combined with Radioactive Seeds Implantation inside and outside of the Stent for Pancreatic Head Carcinoma Complicated by Biliary Obstruction

目的探讨胰头癌伴梗阻性黄疸者在施行经皮胆道支架成形术的基础上,经胆道支架内外置入放射性粒子治疗胰头癌的疗效。方法 23例胰头癌伴梗阻性黄疸患者均行PTCD基础上先行胆道支架成形术,然后经支架留置8 F胆道引流管,最后将装有粒子条的导管经胆道引流管送入所需照射部位,随后配合CT引导下经皮穿刺胰头癌放射性粒子植入术治疗。结果 23例胰头癌伴梗阻性黄疸者,22例成功施行经皮胆道支架成形术,中位支架通畅期为12个月,中位生存期为11.2个月。所有患者均顺利施行支架内外放射性粒子植入术,未出现明显不良反应。术后所有患者的胆红素均降至正常或接近正常(P<0.05)。结论经皮胆道支架成形术后联合支架内外放射性粒子植入术治疗胰头癌伴梗阻性黄疸是一种安全有效的方法,值得临床进一步推广。

Objective To investigate the therapeutic effect of percutaneous biliary stenting combined with radioactive seeds implantation inside and outside of the biliary stent for pancreatic head carcinoma complicated by obstructive jaundice.Methods A total of 23 patients with pancreatic head carcinoma complicated by obstructive jaundice were included in this study. Percutaneous transhepatic choledochus drainage （PTCD） was performed first, which was followed by bihary stenting plasty; then an $F biliary drainage tube was indwelled via the stem; finally the catheter loading radioactive seed stripes was inserted to the site needed for irradiation to coordinate CT-guided percutaneous radioactive seed implantation therapy for pancreatic head carcinoma. Results Of 23 patients suffering from pancreatic head carcinoma complicated by obstructive jaundice, percutaneous biliary stenting plasty was successfully accomplished in 22; the median stent patency period was 12 months, and the median survival time was 11.2 months. Radioactive seeds implantation inside and outside of the biliary stent was successfully performed in all patients with no obvious adverse reactions. After the treatment, the serum bilirubin levels returned to normal or almost normal levels in all patients （P 〈 0.05）. Conclusion For the treatment of pancreatic head carcinoma complicated by obstructive jaundice, percutaneous biliary stenting combined with radioactive seeds implantation inside and outside of the biliary stent is safe and effective. This technique is worth of further promotion in clinical practice.