经皮胆道支架联合近程放疗治疗恶性梗阻性黄疸:一项多中心、回顾性、对照研究

Percutaneous biliary stent combined with brachytherapy for malignant obstructive jaundice:a multicenter retrospective controlled study

目的探讨经皮胆道支架联合^(125)I粒子链近程放射治疗(放疗)对恶性梗阻性黄疸的疗效、安全性及影响预后的因素。方法回顾性分析2017年1月至2020年12月收治的107例经皮胆道支架植入治疗的恶性梗阻性黄疸的患者资料,其中58例接受胆道支架联合^(125)I粒子链近程放疗(研究组),49例仅接受胆道支架植入(对照组)。分析两组患者胆红素的变化、支架通畅时间、并发症发生、总生存期(OS)及影响预后因素。结果研究组和对照组并发症的发生率分别为17.2%、18.3%,差异无统计学意义(P=0.974)。两组患者术后1个月血清总胆红素显著降低(P<0.001)。研究组术后支架通畅时间为(10.0±1.6)个月(95%CI:8.2~12.5),显著优于对照组(5.2±0.4)个月(95%CI:4.1~6.0,P<0.001)。研究组中位OS为(11.2±1.8)个月(95%CI:9.2~12.8),较对照组(8.0±1.1)个月更长(95%CI:8.0~12.8,P<0.001)。多因素分析结果表明,支架联合近程放疗(HR=0.08,95%CI:0.04~0.15,P<0.001)和术后接受进一步抗肿瘤治疗(HR=0.27,95%CI:0.15~0.49,P<0.001)是影响胆道支架通畅的独立危险因素;术前经皮肝穿刺胆道引流术治疗(HR=0.46,95%CI:0.28~0.74,P=0.002)、支架联合近程放疗(HR=0.23,95%CI:0.14~0.39,P<0.001)和术后接受进一步抗肿瘤治疗(HR=0.37,95%CI:0.22~0.61,P<0.001)是影响OS的独立危险因素。结论经皮胆道支架联合近程放疗治疗恶性梗阻性黄疸安全有效,可显著延长胆道支架通畅时间及患者的生存时间。

Objective To investigate the efficacy,safety and prognostic factors of percutaneous biliary stent combined with iodine-125 seed chain brachytherapy(radiotherapy)in the treatment of malignant obstructive jaundice.Methods Data of 107 cases with malignant obstructive jaundice treated with percutaneous biliary stent implantation from January 2017 to December 2020 were retrospectively analyzed.Among them,58 cases received biliary stent combined with iodne-125 seed chain brachytherapy(study group),and 49 cases received biliary stent implantation(control group).The changes of bilirubin,stent patency time,complications,overall survival(OS)and prognostic factors were analyzed in both groups.Results The incidence of complications in the study group and the control group were 17.2%and 18.3%respectively,and the difference was not statistically significant(P=0.974).Serum total bilirubin levels were decreased significantly in both groups at one month after surgery(P<0.001).Postoperative stent patency time was significantly better in the study group(10.0±1.6 months)(95%CI:8.2~12.5)than that in the control group(5.2±0.4 months)(95%CI:4.1~6.0,P<0.001).The median OS was longer in the study group(11.2±1.8 months)(95%CI:9.2~12.8)than that in the control group(8.0±1.1 months)(95%CI:8.0~12.8,P<0.001).Multivariate analysis result showed that stent combined with brachytherapy(HR=0.08,95%CI:0.04~0.15,P<0.001)and receiving further anti-tumor therapy after surgery(HR=0.27,95%CI:0.15~0.49,P<0.001)were independent risk factors affecting the patency of biliary stents.Preoperative percutaneous transhepatic biliary drainage(HR=0.46,95%CI:0.28~0.74,P=0.002),stent combined with brachytherapy(HR=0.23,95%CI:0.14~0.39,P<0.001)and receiving further anti-tumor therapy after surgery(HR=0.37,95%CI:0.22~0.61,P<0.001)were independent risk factors affecting OS.Conclusion Percutaneous biliary stent combined with brachytherapy is safe and effective in the treatment of malignant obstructive jaundice,which can significantly prolong the patency time of biliary stent and the survival time of patients.