| 贡桔,夏宁,陈志瑾,郑云峰,孙锦跃,王忠敏.胆道内照射支架应用于肝门部胆管癌致恶性梗阻性黄疸的初步临床研究[J].中国介入影像与治疗学,2017,14(9):521-524 |
| 胆道内照射支架应用于肝门部胆管癌致恶性梗阻性黄疸的初步临床研究 |
| Preliminary clinical study of biliary tract irradiation stent for hilar cholangiocarcinoma with malignant obstructive jaundice |
| 投稿时间：2017-03-06 修订日期：2017-07-21 |
| DOI：10.13929/j.1672-8475.201703009 |
| 中文关键词: 胆管癌 黄疸,梗阻性 胆道腔内放射治疗 碘-125粒子 |
| 英文关键词:Cholangiocarcinoma Jaundice, obstructive Intraluminal brachytherapy 125I seeds |
| 基金项目:上海市卫生局科研项目（20124137）。 |
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| 中文摘要: |
| 目的 评估携带125I粒子的胆道内照射支架治疗肝门部胆管癌致恶性梗阻性黄疸的有效性及安全性。方法 选取43例因肝门部胆管癌致恶性梗阻性黄疸患者，采用经皮经肝分别穿刺左右侧胆道分支，于肝门部狭窄处植入125I粒子胆道内照射支架，术后留置引流管3~5天，经造影确认支架通畅后予以拔管，封闭穿刺道。记录患者术前与术后的肝功能变化，并观察术后患者生存时间。结果 Bismuth Ⅰ型5例，植入支架5个；Ⅱ型18例，植入支架36个；Ⅲ型4例，植入支架8个；Ⅳ型16例，植入支架25个，患者术前血清总胆红素和直接胆红素分别为（145.54±65.35）μmol/L和（124.73±35.04）μmol/L，术后分别为（65.91±29.43）μmol/L和（35.50±15.12）μmol/L；与术前相比，术后总胆红素、直接胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、C-反应蛋白、γ-谷氨酸转肽酶均显著降低（P均<0.05），乳酸脱氢酶手术前后差异无统计学意义（P=1.050）。患者中位生存期为13个月（3.0~22.5个月），未出现相关胆道穿孔、胰腺炎、严重胆道感染以及胆道出血等并发症。结论 125I粒子胆道内照射支架不仅可引流胆汁，减轻黄疸症状，还可近距离内照射胆道肿瘤，起到治疗作用，可延长患者生存时间，有效治疗肝门部胆管癌致恶性梗阻性黄疸。 |
| 英文摘要: |
| Objective To evaluate the efficacy and safety of biliary stent loaded with 125I seeds in treatment of hilar cholangiocarcinoma with malignant obstructive jaundice.Methods Totally 43 patients with malignant obstructive jaundice caused by cholangiocarcinoma were included. All the patients underwent percutaneous transhepatic puncture of the left and right side branch of the bile duct. In the hilar stenosis, the biliary stent with 125I seeds were implanted, and the biliary drainage tube had been kept in 3 to 5 days after procedures. The drainage tube was removed and the puncture road was closed after the patency of stents were confirmed by cholangiography. The changes of liver function before and after procedures were recorded, and the survival time was observed.Results Five biliary stents loaded with 125I seeds were implanted in type Ⅰ (n=5), 36 in type Ⅱ (n=18), 8 in type Ⅲ (n=4) and 25 in type Ⅳ (n=16). The serum total bilirubin and direct bilirubin of patients before procedures were (145.54±65.35)μmol/L and (124.73±35.04)μmol/L, respectively, and (65.91±29.43)μmol/L and (35.50±15.12)μmol/L respectively after procedures. Compared with preoperative, the total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, C-reactive protein and gamma glutamic transaminase decreased significantly (all P<0.05). The lactate dehydrogenase had no significant difference before and after operation (P=1.050). The median survival time was 13 months (3.0 to 22.5 months). The serious complications such as biliary puncture, pancreatitis, severe biliary tract infection or biliary bleeding were not occurred.Conclusion Biliary stent loaded with 125I seeds is an effective therapy to alleviate symptoms of jaundice and prolong the survival time of patients with malignant obstructive jaundice caused by hilar cholangiocarcinoma. |
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