Y型支架联合粒子条植入治疗Ⅳ型胆管癌的疗效

Effect of Y biliary stent combined with particle implantation on the treatment of type Ⅳ cholangiocarcinoma

目的:通过Y型胆道支架联合^(125)I粒子条植入,来评价此种方法在治疗Bismuth Ⅳ型胆管癌中的临床疗效。方法:采用回顾性研究,收集潍坊市中医院12位失去根治术时机或无法耐受外科手术治疗的Ⅳ型胆管癌患者的临床资料,分析其疗效及并发症。结果:12位患者手术全部成功,支架及125I粒子条均按术前计划成功植入,术后DSA监视下造影显示胆道梗阻消失,胆管通畅,手术成功率100%;术后观察患者皮肤黄疸消失、总胆红素等检测指标明显下降或降至正常范围内;1个月后复查,总胆红素与术前比较差异有统计学意义(t=9.335,P<0.001),直接胆红素值与术前相比差异有统计学意义(t=7.325,P<0.001),中位支架通畅期为19个月,中位生存期为17个月,CEA和CA199两项检测值均有不同程度降低,5例恢复至正常范围。术后除1例患者出现不明原因腹水,其余患者随访期间均未出现支架和/或粒子条移位及放射性损伤等并发症。结论:Y型胆道支架联合125I粒子条植入治疗Ⅳ型胆管癌具有可行性,是一种安全、有效的微创治疗方法,可以作为一种常规治疗方案。

Objective： To evaluate the clinical efficacy of this method in the treatment of type Ⅳ and Bismuth bile duct carcinoma by Y biliary stent combined with 125 I particle implantation. Methods： The clinical data of 12 patients with Ⅳ type bile duct carcinoma who lost the time of radical surgery or could not tolerate surgical treatment in Weifang Hospital of Traditional Chinese Medicine were analyzed retrospectively. The curative effect and complications were analyzed. Results： All 12 patients were all successful surgery. The stent and 125 I particles were implanted successfully according to preoperative plan. After DSA monitoring, the biliary obstruction disappeared and the bile duct was unobstructed. The success rate of operation was 100%; postoperative jaundice disappeared, total bilirubin and other indexes decreased or decreased to normal range; 1 months later, the total bilirubin was statistically different from that before operation（t=9.335, P〈0.001）, and the direct bilirubin value was statistically different from that before operation（t=7.325, P〈0.001）, the median patency period of 19 months, the median survival time was 17 months. The two items of CEA and CA199 were reduced in varying degrees, and 5 cases were recovered to the normal range. Except for 1 patient with unexplained ascites, no complications such as stent and/or particle translocation and radiation injuries were found during the follow-up period. Conclusion： Y biliary stent combined with 125 I seeds implantation is feasible for the treatment of type Ⅳ cholangiocarcinoma. It is a safe and effective minimally invasive treatment, and can be used as a routine treatment regimen.