胆道支架植入加介入化疗方法治疗高位恶性胆道梗阻的体会

Implantation of biliary duct stent combined with interventional chemotherapy in treatment of malignant upper biliary tract obstruction

目的:评估胆道支架植入结合介入化疗在高位恶性胆道梗阻病人中的疗效。方法:对49例植入胆道支架并辅以选择性动脉插管化疗的病人,回顾性分析血清总胆红素(SB)和碱性磷酸酶(AKP)的变化,及支架阻塞发生率和存活时间。结果:术后2周,血清总胆红素和碱性磷酸酶水平较术前明显下降。在39例植入(33.3%)可膨式金属支架病人中,13例(33.3%)发生阻塞,中位阻塞时间为10个月;10例塑料支架均在术后4个月内出现阻塞。本组病人的中位生存时间为12个月,1年生存率为55%,2年生存率为20%。结论:对高位恶性胆道梗阻病人,植入胆道支架同时辅以选择性动脉化疗是合适的治疗方法。可膨式金属支架较塑料支架的效果更好。

Objective To assess the effect of double interventional therapy for malignant upper biliary tract obstruction. Methods The clinical data of 49 patients with malignant upper biliary tract obstruction treated by combination of implantation of biliary duct stent and selective transcatheter intra,arterial chemotherapy were analyzed retrospectively. Results Serum total bilirubin (SB) and AKP levels were markedly decreased after the placement of biliary tract stent. Thirteen of 39 patients planted with self,expanding metal stent were obstructed with in a medium of 10 months. All 10 plastic stents planted were obstructed within 4 months. The medium survival time was 12 months. The one year survival rate was 55%, and the two year survival rate was 20%. Conclusions Placement of biliary duct stent combined with selective arterial chemotherapy was a suitable mode of therapy for malignant upper biliary tract obstruction patients. The effect of self,expanding metal stents was superior to the plastic ones.