胆道支架联合抗肿瘤治疗对肝外胆管癌治疗疗效分析

Curative effect analysis of biliary stent combined anti-tumor therapy for extrahepatic cholangiocarcinoma

目的探讨胆道支架联合抗肿瘤方法治疗肝外胆管癌疗效。方法搜集2013年1月至2014年3月我科收治并于经皮肝穿刺胆道造影术(PTC)中行胆道内钳夹活检病理证实为肝外胆管癌的123例梗阻性黄疸患者临床及影像学资料。60例患者行金属自膨式金属支架置入联合后续抗肿瘤治疗。将此60例患者随机分为A、B、C三组,每组20例患者,其中A组患者行动脉灌注化疗;B组患者行胆道内125I粒子链置入;C组患者行动脉灌注化疗+胆道内125I粒子链置入。同期纳入62例仅行胆道支架置入患者作为对照组。观察对照组、治疗组及不同治疗方式各亚组间手术并发症及黄疸缓解情况,密切随访并比较术后3个月和6个月支架的通畅性。结果所有患者术后通过门诊或电话随访均获得完整随访。术后所有患者总胆红素及直接胆红素均明显下降。治疗组及对照组术后3个月支架通畅率分别为56/60、51/62(P=0.06),其中A、B、C三亚组支架通畅率分别为:18/20、19/20、19/20(P=0.7684)。术后6个月支架通畅率分别为:42/60、27/62(P=0.0032),其中A、B、C三亚组支架通畅率分别为:13/20、11/20、18/20(P=0.0477)。结论支架置入术联合抗肿瘤治疗能明显延长支架通畅时间。而不同抗肿瘤治疗方式之间,灌注化疗联合粒子链内照射治疗的综合治疗方式对延长支架通畅时间更有优势。

Objective To discuss the curative effect of biliary stent combined Anti-tumor therapy for extrahepatic cholangiocarcinoma.Methods The clinical and imaging data of 123 patients diagnosed as extrahepatic cholangiocarcinoma by biliary forceps biopsy in percutaneous transhepatic cholangiography （PTC） were collected. A total of 60 patients of them were treated by self-expanding metallic stents with subsequent anti-tumor therapy. They were randomly divided into A, B, C three groups, 20 patients in each group, and artery infusion chemotherapy for A group, particles chain of 125I into biliary tract for B group and artery infusion chemotherapy combined particles chain of 125I into biliary tract for C group. Meanwhile, we bring 60 patients who only receive biliary stent placement into the study as control group. Observe the operative complication and admission of jaundice of the control group, treatment group and each subgroup that use different therapy, closely follow and compare the 3 months and 6 months of stent patency after the operation. Results All patients with postoperative get complete follow-up by outpatient or telephone, the total bilirubin and direct bilirubin of these patients were signiifcantly decreased. The stent patency rate of treatment group and control group for 3 months after operation is 56/60 and 51/62（P=0.06）, and A、B、C subgroup is 18/20, 19/20, 19/20（P=0.7684）respectively. The stent patency rate for 6 months after operation is 42/60, 27/62 （P=0.0032）, and A、B、C subgroup is 13/20、11/20、18/20（P=0.0477） respectively.Conclusions Stent placement with anti-tumor therapy can obviously prolong stent patency time. And between different anti-tumor treatment, comprehensive treatment methods of artery infusion chemotherapy with particles chain internal radiation therapy have more advantages to prolong stent patency time.