放射性^(125)Ⅰ粒子条胆道支架联合靶向动脉置管化疗药物灌注对恶性梗阻性黄疸的疗效评价

The clinical effect evaluation of ^(125)Ⅰseed-strip stent implantation combined with transcatheter arterial chemoembolization for malignant obstructive jaundice

目的:探讨放射性 ^(125)Ⅰ粒子条支架联合靶动脉置管化疗药物灌注治疗恶性梗阻性黄疸(MOJ)的临床效果。方法:选取我院2012年8月至2016年12月收治的晚期恶性梗阻性黄疸患者120例,分为单纯胆道支架组(A组,40例)、放射性 ^(125)Ⅰ粒子条胆道支架组(B组,40例)以及放射性 ^(125)Ⅰ粒子条胆道支架+靶动脉置管化疗药物灌注组(C组,40例),比较3组患者术后总胆红素(TBIL)、直接胆红素(DBIL)和白蛋白(ALB)的变化、再梗阻间隔时间及生存时间。结果:3组患者术后1周、4周的TBIL、DBIL和ALB均较术前明显减退,差异有统计学意义(P均<0.01)。术后6个月内,3组患者的再梗阻率差异无统计学意义。但术后9个月,B、C组的再发梗阻率明显低于A组(25.0%、26.7%vs. 71.4%),3组间差异有统计学意义(χ~2=21.581,P<0.05);C组术后12个月的再梗阻率低于B组(45.8%vs. 77.3%),差异有统计学意义(χ~2=12.008,P<0.05)。A组术后胆道通畅时间(4.3±0.4)个月<B组(5.9±0.6)个月<C组(9.4±0.8)个月,差异有统计学意义(F=6.897,P<0.01)。C组的中位生存时间为14.6个月,明显长于A、B两组(分别为6.1和9.8个月),差异有统计学意义(Log-rankχ~2=47.211,P<0.05)。结论:放射性 ^(125)Ⅰ粒子条胆道支架植入联合靶向动脉化疗药物灌注在促进黄疸消退,延长支架使用时间,提高患者术后生活质量方面具有独特优势。

Objective:To evaluate the clinical effect of 125I seed-strip stent implantation combined with transcatheter arterial chemoembolization in the treatment of malignant obstructive jaundice.Methods:The clinical data of 120 cases with advanced malignant biliary obstructive jaundice,who lost the surgery chance or did not want to surgery in hospital,were randomly divided into three groups:biliary stent group(group A,n=40),125I biliary stent group(group B,n=40)and 125I biliary stent combined with transcatheter arterial chemoembolization group(group C,n=40).The changes of total bilirubin(TBIL),direct bilirubin(DBIL)and alkaline phosphatase(ALB)levels were observed and analyzed,and the mean biliary patency time and the survival time among three groups were evaluated.Results:Among three groups,the levels of TBIL,DBIL and ALB after 1 or 4 weeks were lower than before,the difference was statistically significant(P<0.01).In group C,the mean biliary patency time and survival time were longer than those in groups A and B(P<0.05).The mean survival time of groups A,B and C was(4.3±0.4)months,(5.9±0.6)months and(9.4±0.8)months,respectively,and the difference was statistically significant(F=6.897,P<0.01).The median survival time of group C was 14.6 months,which was significantly longer than that of groups A and B(6.1 and 9.8 months),and the difference was statistically significant(Log-rankχ^2=47.211,P<0.05).Conclusions:A combination of 125I biliary stent and transcatheter arterial chemoembolization can reduce jaundice,prolong the patency time of stent,and accordingly improve the quality of life of the patient after operation.