经皮肝胆道支架置入术联合肝动脉化疗栓塞术及体外放疗治疗肝门部胆管癌临床效果观察
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摘要
目的观察经皮肝胆道支架置入术联合肝动脉化疗栓塞术及体外放疗治疗肝门部胆管癌患者的临床效果,并分析其预后影响因素。方法回顾性分析辽宁省肿瘤医院自2014年6月至2017年1月收治的34例肝门部胆管癌患者的临床资料。根据治疗方式不同,将患者分入A组(n=13)和B组(n=21)。A组患者仅接受经皮肝胆道支架置入术;B组患者接受经皮肝胆道支架置入术联合肝动脉化疗栓塞术及体外放疗。对患者进行随访,比较两组患者的胆道支架中位通畅时间、胆道支架中位存活期,并采用COX比例风险回归分析影响患者预后的危险因素。结果 B组胆道支架中位通畅时间为15.6个月,明显长于A组的7.0个月,差异有统计学意义(P<0.05)。B组胆道支架中位存活期为19.5个月,明显长于A组的9.6个月,差异有统计学意义(P<0.05)。COX比例风险回归分析显示:Bismuth-Corlett分型、治疗方式是肝门部胆管癌存活期的独立预测因素(P<0.05)。结论经皮肝胆道支架置入术联合肝动脉化疗栓塞术及体外放疗治疗肝门部胆管癌临床效果显著,可明显延长支架通畅时间和患者的存活期。
Objective To observe the clinical effect of percutaneous hepatobiliary stent implantation combined with hepatic artery chemoembolization and external radiotherapy in the treatment of hilar cholangiocarcinoma,and to analyze the prognostic factors.Methods A retrospective study was performed on 34 cases of patients with hilar cholangiocarcinoma who were admitted from June 2014 to January 2017.Patients were divided into the Group A and Group B according to different treatment methods.In Group A,only 13 patients received percutaneous hepatobiliary stent implantation.In Group B,21 patients received percutaneous hepatobiliary stent implantation combined with hepatic arterial chemoembolization and external radiotherapy.Patients were followed up to compare the median biliary stent patency time and median biliary stent survival between the two groups,and COX proportional risk regression analysis was used to analyze the risk factors affecting the prognosis of patients.Results The median patency time of biliary stent in Group B was 15.6 months,significantly longer than that in Group A(7.0 months),and the difference was statistically significant(P<0.05).The median survival of biliary stent in Group B was 19.5 months,significantly longer than that in Group A(9.6 months),(P<0.05).COX proportional risk regression analysis showed that Bismuth-Corlett typing and treatment style were independent predictors of survival of hilar cholangiocarcinoma(P<0.05).Conclusion Percutaneous hepatobiliary stent implantation combined with hepatic arterial chemoembolization and external radiotherapy for the treatment of hilar cholangiocarcinoma has a significant clinical effect,which can significantly prolong the patency time of the stent and the survival of the patients.
Objective To observe the clinical effect of percutaneous hepatobiliary stent implantation combined with hepatic artery chemoembolization and external radiotherapy in the treatment of hilar cholangiocarcinoma,and to analyze the prognostic factors.Methods A retrospective study was performed on 34 cases of patients with hilar cholangiocarcinoma who were admitted from June 2014 to January 2017.Patients were divided into the Group A and Group B according to different treatment methods.In Group A,only 13 patients received percutaneous hepatobiliary stent implantation.In Group B,21 patients received percutaneous hepatobiliary stent implantation combined with hepatic arterial chemoembolization and external radiotherapy.Patients were followed up to compare the median biliary stent patency time and median biliary stent survival between the two groups,and COX proportional risk regression analysis was used to analyze the risk factors affecting the prognosis of patients.Results The median patency time of biliary stent in Group B was 15.6 months,significantly longer than that in Group A(7.0 months),and the difference was statistically significant(P<0.05).The median survival of biliary stent in Group B was 19.5 months,significantly longer than that in Group A(9.6 months),(P<0.05).COX proportional risk regression analysis showed that Bismuth-Corlett typing and treatment style were independent predictors of survival of hilar cholangiocarcinoma(P<0.05).Conclusion Percutaneous hepatobiliary stent implantation combined with hepatic arterial chemoembolization and external radiotherapy for the treatment of hilar cholangiocarcinoma has a significant clinical effect,which can significantly prolong the patency time of the stent and the survival of the patients.
引文
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[12] Suarez-Munoz MA,Fernandez-Aguilar JL,Sanchez-Perez B,et al.Risk factors and classifications of hilar cholangiocarcin-oma[J].World J Gastrointest Oncol,2013,5:132-138.
[13] Paul A,Kaiser GM,Molmenti EP,et al.Klatskin tumors and the accuracy of the bismuth-corlette classification[J].Am Surg,2011,77:1695-1699.
[14] Mangiavillano B,Pagano N,Baron TH,et al.Outcome of stenting in biliary and pancreatic benign and malignant diseases:a comprehensive review[J].World J Gastroenterol,2015,21:9038-9054.
[15] Park SY,Kim JH,Yoon HJ,et al.Transarterial chemoembolization versus supportive therapy in the palliative treatment of unresectable intrahepatic cholangiocarcinoma[J].Clin Radiol,2011,66(4):322-328.
[2] Weiss MJ,Cosgrove D,Herman JM,et al.Multimodal treatment strategies for advanced hilar cholangiocarcinoma[J].Langenbecks Arch Surg,2014,399(6):679-692.
[3] Tan JC,Coburn NG,Baxter NN,et al.Surgical management of intrahepatic cholangiocarcinoma-a population-based study[J].Ann Surg Oncol,2008,15:600-608.
[4] Sharaiha RZ,Natov N,Glockenberg KS,et al.Comparison of metal stenting with radiofrequency ablation versus stenting alone for treating malignant biliary strictures:is there an added benefit[J].Dig Dis Sci,2014,59:3099-3102.
[5] Shim DJ,Gwon DI,Han K,et al.Percutaneous metallic stent placement for palliative management of malignant biliary hilar obstruction[J].Krean J Radiol,2018,19(4):597-605.
[6] Valle J,Wasan H,Palmer DH,et al.Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer[J].N Engl J Med,2010,362:1273-1281.
[7] Boehm LM,Jayakrishnan TT,Miura JT,et al.Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma[J].J Surg Oncol,2015,111(2):213-220.
[8] Kopek N,Holt MI,Hansen AT,et al.Stereotactic body radiotherapy for unresectable cholangiocarcinoma[J].Radiother Oncol,2010,94:47-52.
[9] Bonnel D,André T,Mader B.Malignant biliary obstruction,general review and clinical practice[J].Bulletin Du Cancer,2013,100(5):443-452.
[10] Rerknimitr R,Angsuwatcharakon P.Asia-pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma[J].J Gastroenterol Hepatol,2013,28:593-607.
[11] Pranculis A,Kievisas M,Kievisiene L.Percutaneous transhepatic biliary stenting with uncovered self-expandable metallic stents in patients with malignant biliary obstruction-efficacy and survival analysis[J].Pol J Radiol,2017,82:431-440.
[12] Suarez-Munoz MA,Fernandez-Aguilar JL,Sanchez-Perez B,et al.Risk factors and classifications of hilar cholangiocarcin-oma[J].World J Gastrointest Oncol,2013,5:132-138.
[13] Paul A,Kaiser GM,Molmenti EP,et al.Klatskin tumors and the accuracy of the bismuth-corlette classification[J].Am Surg,2011,77:1695-1699.
[14] Mangiavillano B,Pagano N,Baron TH,et al.Outcome of stenting in biliary and pancreatic benign and malignant diseases:a comprehensive review[J].World J Gastroenterol,2015,21:9038-9054.
[15] Park SY,Kim JH,Yoon HJ,et al.Transarterial chemoembolization versus supportive therapy in the palliative treatment of unresectable intrahepatic cholangiocarcinoma[J].Clin Radiol,2011,66(4):322-328.