125I粒子条联合胆道内支架治疗恶性梗阻性黄疸的临床疗效

Application of 125I seeds combined with biliary stent implantation in the treatment of malignant obstructive jaundice

目的评价125I粒子条联合胆道内支架治疗恶性梗阻性黄疸的可行性和疗效。方法收集2010年9月至2013年2月山东省烟台毓璜顶医院收治的恶性梗阻性黄疸患者50例，其中行125I粒子条联合胆道内支架治疗24例（研究组），单纯行胆道内支架术26例（对照组）。分析两组患者治疗前后总胆红素、直接胆红素、肿瘤相关标志物的变化情况，以及胆道内支架的通畅状况和患者的生存时间。结果研究组24例患者共成功置入125I粒子条30条，共450枚粒子。研究组和对照组患者在治疗后黄疸情况均明显改善。研究组患者术后2个月糖类抗原199（CA-199）和糖类抗原242（CA-242）的水平，与术前比较，均明显下降（P=0．003和P=0．004）；而癌胚抗原（CEA）的水平与术前比较虽有下降，但差异无统计学意义（P〉0．05）。对照组患者术后2个月CA-199、CA-242和CEA的水平与术前比较，差异均无统计学意义（均P〉0．05）。研究组患者的支架通畅率为83．3％（20／24），对照组为57．7％（15／26），差异有统计学意义（P=0．048）。研究组患者的支架通畅时间为1～15．5个月，平均9．84个月；对照组患者的支架通畅时间为0．8～9个月，平均5．57个月，差异有统计学意义（P=0．018）。研究组患者的中位生存时间为10．2个月，对照组患者的中位生存时间为5．4个月，差异有统计学意义（P〈0．05）。结论自胆管引流管内置入125I粒子条的方法可有效抑制胆管内皮细胞的增生、控制肿瘤生长，明显延长恶性梗阻性黄疸患者的支架通畅时间和总生存时间，是一种安全、有效的方法。

Objective To study the feasibility and therapeutic effect of the application of 125I seeds combined with biliary stent implantation on the treatment of malignant obstructive jaundice. Methods Fifty patients with malignant obstructive jaundice treated from September 2010 to February 2013 in Yantai Yuhuangding Hospital were included in this study. Among them, 24 patients received biliary stent implantation combined with 125I seeds intraluminal brachytherapy as experimental group, and 26 were treated by biliary stent implantation as control group.The total bilirubin, direct bilirubin and tumor markers （CA- 199, CA-242, CEA） before and after surgery, the biliary stent patency status was assessed, and the survival time was evaluated. Results The 24 patients in experimental group were implanted with 30 125I seeds successfully in a total of 450 seeds. Jaundice was improved greatly in both groups. The CA-199 and CA-242 after treatment in the experimental group were significantly decreased than that before treatment （P = 0.003 and P=0.004）.CEA was also decreased, but showed no statistical significance （P〉0.05）. There were no significant improvement comparing the CA-199, CA-242 and CEA before and 2 months after surgery in the control group （P〉0.05）.The rate of biliary stent patency was 83.3% （20/24） in the experimental group and 57.7% （15/26） in the control group （P=0.048）. The mean biliary stent pateney time in the experimental group was 9.84 months （range 1-15.5 months）.The mean biliary stent patency time in the control group was 5.57 months （range 0.8-9 months）. There was a significant difference between the two groups （P=0.018）. The median survival time was 10.2 months in the experimental group and 5.4 months in the control group （P〈0.05）. Conclusion 125I seeds combined with biliary stent implantation can inhibit the proliferation of vascular endothelial cells and the growth of tumor effectively, and can prolong the biliary stent patency time and the survival time obviously for patients with malignant obstructive jaundice, therefore, is a safe and effective treatment in this malignancy.