经皮胆道支架和^(125)I粒子条腔内植入联合动脉灌注化疗治疗恶性梗阻性黄疸的疗效分析

Percutaneous implantation of biliary stent and ^(125)I seed strips combined with transarterial infusion chemotherapy for the treatment of malignant obstruction jaundice:analysis of curative effect

目的评估经皮胆道植入胆道支架和^(125)I粒子条联合TACE在治疗恶性梗阻性黄疸中的安全性及有效性。方法回顾性分析2015年11月至2018年1月收治的60例恶性梗阻性黄疸患者的临床资料,其中13例患者接受了胆道支架联合^(125)I粒子条的植入后规律行5次TACE(实验组),另外47例患者仅进行了胆道支架联合和^(125)I粒子条的植入(对照组)。对两组基线资料按照1∶2进行配对后分析两治疗方式的临床效果。结果倾向性匹配后,实际配对完成患者10对,配对后组间基线资料具有可比性,实验组支架通畅期中位数为320 d,生存期中位数为376 d,对照组支架通畅期中位数为162 d,生存期中位数为186 d,实验组优于对照组(P<0.05)。术后轻微并发症均得到控制,两组均未发生严重并发症。结论金属支架和^(125)I粒子条植入联合TACE对恶性梗阻性黄疸的治疗是有效和安全的,可以提高支架通畅时间和患者生存时间。

Objective To evaluate the safety and effectiveness of percutaneous implantation of biliary stent and ^(125)I seed strips combined with transarterial infusion chemotherapy(TAIC)in treating malignant obstruction jaundice(MOJ).Methods The clinical data of 60 patients with MOJ,who were admitted to the First Affiliated Hospital of Nanjing Medical University of China to receive treatment during the period from November 2015 to January 2018,were retrospectively analyzed.Among the 60 patients,percutaneous implantation of biliary stent and ^(125)I seed strips with subsequent 5 sessions of TAIC was carried out in 13 patients(study group)and only percutaneous implantation of biliary stent and ^(125)I seed strips was adopted in47 patients(control group).Based on the baseline data the propensity score matching(PSM)at 1∶2 ratio pairing was conducted,the curative effect of the two groups were analyzed.Results By using PSM method,10 pairs were actually obtained.The baseline data between paired groups were comparable.In the study group the median stent patency time and survival time were 320 days and 376 days respectively,which were significantly longer than 162 days and 186 days respectively in the control group(P<0.05).Postoperative complications were mild,and all of which were controlled.No severe complications occurred in both groups.Conclusion For the treatment of MOJ,percutaneous implantation of biliary stent and ^(125)I seed strips with subsequent TAIC is clinically effective and safe.This therapy can improve stent patency time and patient’s survival time.