经皮经肝胆道后装放疗导管预置术治疗胆道壶腹癌10例

Percutaneous transhepatic biliary preset implantation of after-loading radiotherapy catheter for the treatment of bile duct carcinoma of ampulla: preliminary results of 10 cases

目的探讨经皮肝穿刺胆道后装放疗导管预置技术的可行性和安全性。方法选择10例壶腹癌患者,在经皮肝穿刺技术行胆道支架植入术后,经导引导丝送入后装放疗导管,依据病变部位对导管头端及通过导管置入的假源进行定位,每次内照射前CT或透视下复位,给与足量内照射。结果 10例患者均顺利完成经皮肝穿胆道支架置入术和假源定位,并于术后5~7 d内完成足量内照射,治疗过程中未发生严重并发症。结论经皮肝穿胆道后装放疗导管预置技术安全可行,其成功率高、并发症少,能有效提高胆道支架通畅率,适用于姑息治疗的壶腹癌患者,值得应用和推广。

Objective To discuss the safety and feasibility of percutaneous transhepatic biliary preset implantation of after-loading radiotherapy catheter in treating bile duct carcinoma of ampulla. Methods A total of 10 patients with carcinoma of ampulla were collected. After percutaneous transhepatic biliary stent implantation was accomplished, the after-loading radiotherapy catheter was inserted via the guide wire. Based on the lesion＇s location, the positioning of both the catheter tip and the simulation radioactive source implanted through catheter was conducted. Each time before irradiation, the positions of the catheter and the radioactive source were reset under CT or fluoroscopic guidance in order to ensure that the lesion could get adequate internal irradiation dose. Results Pereutaneous transhepatie biliary implantation of after-loading radiotherapy catheter and the positioning of simulation radioactive source were successfully accomplished in all 10 patients, and the total internal irradiation dose was completed within 5-7 days after catheter implantation. No severe complications occurred during the whole therapeutic process. Conclusion The technology of pereutaneous transhepatie biliary preset implantation of after-loading radiotherapy catheter is safe and feasible, it carries high success rate with less complications. This therapy can improve the patency rate of biliary stent, and, as a palliative treatment, it is suitable for patients with carcinoma of ampulla. This treatment is worthy of application and promotion. （J Intervent Radiol, 2017, 26： 427-430）