胆道支架植入联合胆管腔内灌注化疗在晚期肝外胆管癌中的应用

Effect of biliary stent implantation combined with intrabile duct perfusion chemotherapy in the treatment of advanced extrahepatic cholangiocarcinoma

目的:探讨胆道支架植入联合胆管腔内灌注化疗在晚期胆管癌中的治疗效果。方法:回顾性分析经皮经肝胆道支架置入(PTBS,PTBS组)或PTBS联合腔内灌注化疗(PTBS+腔内灌注化疗组)的86例晚期EHCC病人的临床资料,分析病人肝功能的改善情况、并发症发生情况及术后生存情况等。Kaplan-Meier曲线及Cox比例风险回归模型分析影响病人术后总体生存时间(OS)的相关因素。结果:与术前相比,2组病人术后1月、3月及6月血清中ALT、AST及TBIL水平均有不同程度的降低(P<0.05),且PTBS+腔内灌注化疗组病人下降趋势比PTBS组更为显著;PTBS+腔内灌注化疗组病人术后血清ALB水平增加更为明显。2组病人术后并发症的发生差异无统计学意义(P>0.05)。PTBS组病人生存时间中位数为7个月,1年生存率为11.3%;PTBS+腔内灌注化疗组病人生存时间中位数为10个月,1年生存率为37.5%。log-rank检验提示PTBS联合腔内灌注化疗可改善EHCC病人的预后,延长其生存期。Cox多因素回归模型结果表明接受PTBS+腔内灌注化疗是预后独立的保护性因素(HR=0.46,95%CI:0.23~0.92,P<0.05)。结论:与单纯PTBS相比,PTBS联合腔内灌注化疗可改善EHCC病人的预后,延长其生存期。PTBS联合腔内灌注化疗可获得更佳治疗效果,值得临床进一步探索与研究。

Objective:To explore the effects of biliary stent implantation combined with intrabile duct perfusion chemotherapy in the treatment of advanced extrahepatic cholangiocarcinoma(EHCC). Methods:The clinical data of 86 advanced EHCC patients treated with percutaneous extrahepatic biliary stenting(PTBS group) or PTBS combined with intraductal perfusion chemotherapy(PTBS combined with intraductal perfusion chemotherapy group) were retrospectively analyzed.The improvement of liver function,complications and postoperative survival were analyzed.The influencing factors of overall survival(OS) were analyzed using Kaplan-Meier curve and Cox regression model. Results:Compared with before operation,the serum levels of ALT,AST and TBIL significantly reduced after 1,3 and 6 months of operation( P <0.05),the decreasing degree of which in PTBS combined with intraductal perfusion chemotherapy group was more obviously than that in PTBS group,and the increasing degree of ALB level in PTBS combined with intraductal perfusion chemotherapy group was more obviously than that in PTBS group.The difference of the incidence rate of postoperative complication between two groups was not statistically significant( P >0.05).The median survival time and 1-year survival rate in PTBS group were 7 months and 11.3%,respectively.The median survival time and 1-year survival rate in PTBS combined with intraductal perfusion chemotherapy group were 10 months and 37.5%,respectively.Log-rank test suggested that the PTBS combined with intraductal perfusion chemotherapy could improve the prognosis,and prolong the survival of EHCC patients.Cox regression analysis showed that the PTBS combined with intraductal perfusion chemotherapy was an independent protective factor for prognosis( HR =0.46,95% CI :0.23-0.92,P <0.05). Conclusions:Compared with the simple PTBS,the PTBS combined with intraductal perfusion chemotherapy can improve the prognosis,and prolong the survival of EHCC patients.The PTBS combined with intraductal perfusion chemotherapy has good treatment effect,which is worthy of further clinical exploration and research.