胆道粒子支架植入联合TAI序贯治疗不可切除肝门部胆管癌的临床疗效差异

Comparative analysis of clinical efficacy of radiation-emitting metallic stents combined with transarterial infusion chemotherapy sequential treatment for unresectable hilarcholangiocarcinoma

目的探讨胆道粒子支架植入联合经导管动脉灌注化疗序贯治疗对不可切除肝门部胆管癌(hilar cholangiocarcinoma,HCCA)的临床价值。方法选取本院收治不可切除HCCA 61例患者,其中对照组28例接受~(125)I粒子链及自膨式金属胆道支架(self-expandable metallic biliary stent,SEMS)植入,联合组33例接受~(125)I粒子链及SEMS植入后行TAI序贯治疗(TAI包括注入顺铂25 mg/m~2与吉西他滨1000 mg/m~2溶于生理盐水后灌注,每3周重复1次),比较两组患者的术后疗效、生存时间、支架通畅时间和并发症。结果两组技术成功率100%,术后1周、1个月、3个月内两组TBIL、AST、ALT较术前有明显改善(P<0.05),联合组对照组中位支架通畅时间分别为7.9个月、6.3个月,中位生存时间分别为11.4个月、6.7个月,组间差异均有统计学意义(P<0.05)。两组术后均未出现严重并发症。结论胆道粒子支架联合TAI序贯治疗是治疗HCCA安全、有效的方法,有效延长支架通畅时间及总生存期。

Objective To investigate the clinical efficacy,survival status and prognosis of radiation-emitting metallic stents(REMS)implantation combined with sequential transcatheter arterial infusion chemotherapy(TAI)in the treatment of unresectable hilar cholangiocarcinoma(HCCA).Methods 61 cases of unresectable HCCA treated in our hospital from August 2017 to October 2021 were studied retrospectively.28 cases in the control group received REMS implantation,and 33 cases in the combined group received sequential TAI therapy(TAI consisted of infusion of cisplatin 25 mg/m 2 and gemcitabine 1000 mg/m 2 dissolved in normal saline,and was repeated every 3 weeks)after REMS implantation.The clinical efficacy,stent patency time and over survival between the two groups were compared.Results The technical success rate of the two groups was 100%.Within 1 week,1 month and 3 months after operation,TBIL,AST and ALT in the two groups were significantly improved as compared with those before operation.The median stent patency time in the combined group and control group was 7.9 months and 6.3 months respectively,and the median over survival time was 11.4 months and 6.7 months respectively.There were significant differences between the two groups(P<0.05).There were no serious postoperative complications in both groups.Conclusion REMS combined with TAI sequential therapy is a safe and effective method for the treatment of HCCA,which can significantly prolong the stent patency time and overall survival time of patients.