经皮胆道支架置入联合^(125)I粒子腔内照射治疗肝门部胆管癌的疗效观察

Effect of percutaneous biliary stenting combined with ^(125)I particle intraluminal irradiation in the treatment of hilar cholangiocarcinoma

目的:探讨经皮胆道支架置入联合^(125)I粒子腔内照射治疗肝门部胆管癌的疗效。方法:选取2014年1月至2015年7月海南医学院第一附属医院收治的肝门部胆管癌患者68例,其中30例患者单纯给予经皮胆道支架置入(对照组),38例患者采用经皮胆道支架置入联合^(125)I粒子腔内照射治疗(观察组)。所有患者均随访2年,对比分析两组患者术前、术后1个月、3个月肝功能以及肿瘤体积变化情况,术后支架通畅及新发梗阻发生情况和生存时间的差异。结果:两组患者术后1个月、3个月肝功能指标均较治疗前明显改善(均P<0.05),且观察组优于对照组(P<0.01)。术后1个月、3个月,观察组肿瘤最大直径、最小直径均明显小于对照组和治疗前(P<0.01),而对照组较治疗前显著增大(P<0.05)。观察组术后6个月支架通畅率为94.80%,明显高于对照组的76.67%(χ2=4.77,P=0.03)。所有患者均成功完成手术治疗,无围术期死亡。观察组中位生存时间为20个月,对照组为13个月;观察组术后1年、2年累积生存率明显高于对照组(P<0.05)。结论:经皮胆道支架置入联合^(125)I粒子腔内照射治疗肝门部胆管癌患者的临床效果显著,能有效改善患者肝功能,延长生存时间,值得临床推广应用。

Objective： To investigate the efficacy of percutaneous biliary stenting combined with ^125 I intraluminal irradiation in the treatment of hilar cholangiocarcinoma.Methods： Sixty-eight patients with hilar cholangiocarcinoma treated in our hospital from January 2014 to July 2015 were selected,and assigned to receive either percutaneous biliary stenting （ n =30,control group） or percutaneous biliary stenting combined with ^125 I intraluminal irradiation （ n =38,observation group）.All patients were followed up for 2 years.The liver function,tumor volume,difference in stent patency and survival time were observed and recorded.Results： The liver function indexes of both groups were significantly improved after 1 and 6 months of treatment （ P 〈0.05）,and the improvement was more significant in the observation group （ P 〈0.01）.After 1 and 3 months of operation,the maximum diameter and the minimum diameter of the tumors in the observation group were significantly lower than those in the control group and before surgery （ P 〈0.01）,while the tumor volume was increased in the control group （ P 〈0.05）.In the observation group,the stent patency rate was 94.80% at 6 months post-operation,which was significantly higher than that in the control group （76.67%） （χ^ 2 =4.77, P =0.03）.Two groups of operations were successfully completed without death.The median survival time in the observation group and the control group was 20 months and 13 months,respectively.The 1-year and 2-year cumulative survival rates in the observation group were significantly higher than those in the control group （ P 〈0.05）.Conclusion： Percutaneous biliary stent implantation combined with 125 I intracavitary irradiation was effective in the treatment of hilar cholangiocarcinoma.This combination could improve the liver function and prolong the survival time.