可移动^(125)I粒子条联合经皮肝胆管内外引流术治疗肝门部胆管癌的临床价值

Clinical value of movable^(125)I radioactive particle strip combined with percutaneous transhepatic cholangiodrainage in the treatment of hilar cholangiocarcinoma

目的探讨可移动^(125)I粒子条联合经皮肝胆管内外引流术(percutaneous transhepatic cholangiodrainage,PTCD)治疗肝门部胆管癌(hilar cholangiocarcinoma,HCCA)的短期临床疗效。方法回顾性分析江南大学附属医院2020年7月—2021年9月收治的HCCA患者40例为研究对象,根据其不同的手术方式分为观察组(19例)与对照组(21例)。观察组采用可移动放射性^(125)I粒子条联合PTCD的治疗方法,对照组采用直型^(125)I粒子条联合胆道支架治疗。对比分析2组患者术前及术后的肝功能改善情况、引流通畅时间、手术时间、手术费用、术后并发症发生率、短期生存期等。结果2组患者在治疗后,肝功能异常指标均较治疗前明显降低,肝功能缓解程度无明显差异(P>0.05)。观察组患者的引流通畅时间167.0 d优于对照组的152.0 d;两组胆道感染发生率分别为15.79%及61.90%,存在统计学意义(P=0.01)。两组患者的手术时间及费用比较:观察组较对照组中位手术时间缩短大约20 min,中位手术费用少大约3000元;观察组术后并发症发生率明显低于对照组(P值均<0.05)。两组患者术后随访6~20个月,中位随访时间为13个月,观察组患者粒子条更换次数共18人次,短期生存率高于对照组(78.95%vs 52.38%)。结论可移动^(125)I放射性粒子条植入联合PTCD治疗HCCA患者总体安全有效,手术时间缩短,胆道感染发生率更低,短期生存率更高。

Objective To investigate the clinical efficacy of movable^(125)I particle strip combined with percutaneous transhepatic cholangiodrainage(PTCD)in the treatment of Hilar Cholangiocarcinoma(HCCA).Methods Forty HCCA patients were retrospective analyzed as the research objects from Affiliated Hospital of Jiangnan University from October 2020 to October 2021,and they were divided into the study group(19 cases)and the control group(21 cases)according to the different treatment.Patients in study group were treated by movable^(125)I radioactive seed implantation combined with PTCD,and the control group patients were treated by straight^(125)I radioactive seed implantation combined with percutaneous biliary stenting.The improvement of liver function before and after surgery,time to drainage patency,operation time,operation cost,incidence of postoperative complications and short survival time were compared and analyzed between the two groups.Results After treatment,the indexes of abnormal liver function in both groups were significantly lower than those before treatment.There was no significant difference in the remission of liver function between the two groups(P>0.05).The drainage patency time of the study group was 167.0 d better than that of the control group(152.0 d).The incidence of biliary tract infection was 15.79%and 61.90%in the two groups,respectively,which was statistically significant.The median operation time in the study group was about 20 minutes shorter than that in the control group,and the median operation cost in the study group was about 3000 yuan less than that in the control group,and the incidence of postoperative complications in the study group was significantly lower than that in the control group(all P<0.05).Patients in two groups were followed up for 6 to 20 months,and the median follow-up time was 13 months.The total number of particle strip changes in the observation group was 18,and short-term survival rate was higher than that of the control group(78.95%vs 52.38%).Conclusions Movable^(125)I radioactive seed strip implantation combined with PTCD is generally safe and effective in the treatment of HCCA patients,with shorter operative time,lower incidence of biliary tract infections,and higher short-term survival rates.