新型^(125)I双链胆道引流管治疗胆管癌合并黄疸的近期疗效(附9例报告)

Short term effect of new double ^(125)I chain biliary drainage tube for the treatment of cholangiocarcinoma with jaundice(report of 9 cases)

目的探讨透视监控下新型^(125)I粒子双链胆道引流管和胆管支架联合治疗胆管癌合并梗阻性黄疸的临床效果。方法9例胆管癌合并梗阻性黄疸患者接受透视监控下^(125)I粒子双链胆道引流管和胆管支架置入,记录操作成功率、操作时间和并发症;近距离放疗治疗计划系统(TPS)计算局部累积剂量;观察术后2、4、6个月胆管支架通畅和患者生存情况;比较术前和术后2个月白细胞、红细胞、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、白蛋白、CA19-9变化和肿瘤最大径。结果所有患者均顺利完成新型引流管和胆管支架置入,技术成功率100%;2例(22.2%)发生胆管少量出血,但未见胆管穿孔、腹膜炎、胰腺炎、大量出血等严重并发症发生。2个月平均局部累积剂量76.3 Gy;2、4、6个月支架通畅率分别为100%、88.9%、66.7%。中位随访8.5个月,1例患者死亡,其余患者均存活;术后2个月谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、CA19-9、肿瘤最大径均较前明显下降,有统计学差异(P<0.05);白细胞、红细胞、白蛋白较前无明显变化,无统计学差异(P>0.05)。结论新型一体化可携带^(125)I粒子双链引流管和胆管支架联合治疗胆管癌合并梗阻性黄疸安全可行,可实现胆汁引流与近距离放疗双重作用,近期疗效显著,但远期疗效仍需进一步观察。

Objective To investigate the clinical effect of new double ^(125)I chain biliary drainage tube and biliary stent for the treatment of cholangiocarcinoma with obstructive jaundice under fluoroscopic monitoring.Methods Nine patients with cholangiocarcinoma complicated with obstructive jaundice were treated with ^(125)I seed double strand biliary drainage tube and biliary stent under fluoroscopic monitoring.The technical success rate,operation time and complications were recorded.The local cumulative irradiation dose was calculated by treatment plan system(TPS).The 2-,4- and 6- month of biliary stent patency and overall survival were observed.The white blood cells(WBC),red blood cells(RBC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TB),direct bilirubin(DB),albumin,CA19-9 and the maximum diameter of tumor were compared before and 2-month later.Results All cases underwent double 125I chain drainage tube and stent successfully,which means 100% technical success rate.2 cases(22.2%)had a small amount of bile duct bleeding without bile duct perforation,peritonitis,pancreatitis,massive bleeding and other serious complications.The average local cumulative dose was 76.3 Gy,2-,4-,6-month stent patency rate were 100%,88.9%,66.7%,respectively.During the median follow-up of 8.5 months,1 patient died and the rest cases survived.ALT,AST,TB,DB,CA19-9,tumor maximum diameter decreased significantly(P<0.05),while WBC,RBC and albumin showed no significantly changes comparing with that of 2-month later(P>0.05).Conclusions It is safe and feasible to treat cholangiocarcinoma with obstructive jaundice by the combination of double ^(125)I chain and biliary stent,which can achieve the dual effects of bile drainage and brachytherapy.The short-term effect is satisfactory,and the long-term effect needs further observation.