比较两种不同粒子条制作及植入方法联合胆道支架治疗恶性梗阻性黄疸

Comparison of the preparation of two different ^(125)I seed-strips and ^(125)I seed-strip implantation combined with biliary stent for malignant obstructive jaundice

目的比较分析两种不同粒子条制作及植入方法联合胆道支架治疗恶性梗阻性黄疸(MOJ)的临床疗效和安全性。方法分析2016年1月至2020年5月收治65例MOJ患者,38例行直型粒子条联合金属支架植入,27例行螺旋型粒子条联合金属支架植入,分析两组患者术后肝功能改善情况、支架通畅时间、生存期,术中、术后并发症情况。结果两组患者术后1个月肝功能较穿刺引流术前均有明显改善,但两组肝功能参数比较均无明显差异(P>0.05)。直型组的术中并发症的发生率明显高于螺旋组(P<0.05),术后出血及胆汁瘘的发生率直型组亦高于螺旋组(P<0.05)。结论胆道支架联合粒子条植入治疗MOJ安全有效,可延长患者支架通畅时间和生存期;与直型粒子条相比,螺旋型粒子条的植入方法可明显提高患者术中的舒适度及耐受性,同时减少术中、术后并发症的发生。

Objective To compare the clinical efficacy and safety of two125I seed-strips,which are prepared by different methods,combined with biliary stent in treating malignant obstructive jaundice(MOJ).Methods The clinical data of a total of 65 MOJ patients,who were admitted to the First Affiliated Hospital of Anhui Medical University of China between January 2016 and May 2020 to receive treatment,were retrospectively analyzed.Straight125I seed-strip combined with biliary metal stent implantation was adopted in38 patients(straight type group),while spiral125I seed-strip combined with biliary metal stent implantation was employed in 27 patients(spiral type group).The postoperative liver functions,stent patency duration,survival time,intraoperative and postoperative complications were compared between the two groups.Results One month after treatment,the liver functions were obviously improved in both groups when compared with preoperative ones,although no statistically significant differences in the liver function indexes existed between the two groups(P>0.05).The intraoperative incidence of complications in the straight type group was strikingly higher than that in the spiral type group(P<0.05),the postoperative incidence of bleeding and biliary fistula in the straight type group was also higher than those in the spiral type group(P<0.05).Conclusion For the treatment of MOJ,125I seed-strip combined with biliary metal stent implantation is clinically safe and effective,it can prolong the stent patency duration and the patient’s survival time.Compared with straight125I seedstrip,the implantation of spiral125I seed-strip can remarkably improve the patient’s comfortableness and tolerance,and reduce the occurrence of both intraoperative and ostoperative omplications.