放射性~(125)Ⅰ粒子条胆道支架联合靶向动脉置管化疗药物灌注对恶性梗阻性黄疸的疗效评价
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摘要
目的:探讨放射性 ~(125)Ⅰ粒子条支架联合靶动脉置管化疗药物灌注治疗恶性梗阻性黄疸(MOJ)的临床效果。方法:选取我院2012年8月至2016年12月收治的晚期恶性梗阻性黄疸患者120例,分为单纯胆道支架组(A组,40例)、放射性 ~(125)Ⅰ粒子条胆道支架组(B组,40例)以及放射性 ~(125)Ⅰ粒子条胆道支架+靶动脉置管化疗药物灌注组(C组,40例),比较3组患者术后总胆红素(TBIL)、直接胆红素(DBIL)和白蛋白(ALB)的变化、再梗阻间隔时间及生存时间。结果:3组患者术后1周、4周的TBIL、DBIL和ALB均较术前明显减退,差异有统计学意义(P均<0.01)。术后6个月内,3组患者的再梗阻率差异无统计学意义。但术后9个月,B、C组的再发梗阻率明显低于A组(25.0%、26.7%vs. 71.4%),3组间差异有统计学意义(χ~2=21.581,P<0.05);C组术后12个月的再梗阻率低于B组(45.8%vs. 77.3%),差异有统计学意义(χ~2=12.008,P<0.05)。A组术后胆道通畅时间(4.3±0.4)个月 Objective: To evaluate the clinical effect of ~(125)Ⅰ seed-strip stent implantation combined with transcatheter arterial chemoembolization in the treatment of malignant obstructive jaundice. Methods : The clinical data of 120 cases with advanced malignant biliary obstructive jaundice, who lost the surgery chance or did not want to surgery in hospital, were randomly divided into three groups: biliary stent group(group A, n=40),~(125)Ⅰ biliary stent group(group B,n =40) and ~(125)Ⅰ biliary stent combined with transatheter arterial chemoembolization group(group C, n=40). The changes of total bilirubin(TBIL), direct bilirubin(DBIL) and alkaline phosphatase(ALB) levels were observed and analyzed, and the mean biliary patency time and the survival time among three groups were evaluated. Results: Among three groups, the levels of TBIL, DBIL and ALB after 1 or 4 weeks were lower than before, the difference was statistically significant(P<0.01). In group C,the mean biliary patency time and survival time were longer than those in groups A and B(P<0.05). The mean survival time of groups A, B and C was(4.3 ±0.4) months,(5.9 ±0.6) months and(9.4 ±0.8) months,respectively, and the difference was statistically significant(F=6.897, P< 0.01). The median survival time of group C was 14.6 months, which was significantly longer than that of groups A and B(6.1 and 9.8 months), and the difference was statistically significant(Log-rank χ~2=47.211,P< 0.05). Conclusions: A combination of ~(125)Ⅰ biliary stent and transcatheter arterial chemoembolization can reduce jaundice, prolong the patency time of stent, and accordingly improve the quality of life of the patient after operation.
引文
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[12]张浩,向华,张永琎,等.肝动脉置管化疗栓塞治疗不可切除胆管细胞型肝癌的疗效观察[J].中国临床医学影像杂志,2017,28(4):286-290.
[13]林辉,苏香花.CT引导下125I粒子植入联合支气管动脉灌注化疗栓塞治疗晚期非小细胞肺癌的效果观察[J].中国当代医药,2017,24(5):51-54.
[2]姚红响,陈根生,叶冠雄,等.胆道支架联合125I粒子条治疗恶性梗阻性黄疸[J].介入放射学杂志,2014,23(10):893-896.
[3]陈烨,姚红响,曾群,等.胆道支架联合125I粒子条治疗恶性梗阻性黄疸的手术配合[J].护理学杂志,2015,30(6):36-38.
[4]Hu X,Qiu H,Zhang L,et al.Recurrent gliomas:comparison of computed tomography(CT)-guided 125I seed implantation therapy and traditional radiochemotherapy[J].Cancer Biol Ther,2012,13(10):840-847.
[5]张万高,丁以锟,纵慧敏,等.经皮肝穿刺胆道引流胆道腔内射频消融联合支架置入治疗恶性梗阻性黄疸的疗效分析[J].安徽医学,2015,36(8):992-995.
[6]Brito AF,Abrantes AM,Encarnacao JC,et al.Cholangiocarcinoma:from molecular biology to treatment[J].Med Oncol,2015,32(11):245.
[7]赵媛,王荣福,刘鹏程.放射性125I粒子植入治疗恶性肿瘤现状与进展[J].肿瘤学杂志,2010,16(6):427-431.
[8]Mukewar S,Gupta A,Baron TH,et al.Endoscopically inserted nasobiliary catheters for high dose-rate brachytherapy as part of neoadjuvant therapy for perihilar cholangiocarcinoma[J].Endoscopy,2015,47(10):878-883.
[9]Im JH,Seong J,Lee IJ,et al.Surgery alone versus surgery followed by chemotherapy and radiotherapy in resected extrahepatic bile duct cancer:treatment outcome analysis of 336 patients[J].Cancer Res Treat,2016,48(2):583-595.
[10]Wang T,Liu S,Zheng YB,et al.Clinical study on using 125I seeds articles combined with biliary stent implantation in the treatment of malignant obstructive jaundice[J].Anticancer Res,2017,37(8):4649-4653.
[11]苗同国,刘琼,邵明亮,等.经颈内静脉植入125I粒子条及支架联合TACE治疗原发性肝癌合并Ⅲ型门脉癌栓一例[J].中华介入放射学电子杂志,2018,6(3):274-276.
[12]张浩,向华,张永琎,等.肝动脉置管化疗栓塞治疗不可切除胆管细胞型肝癌的疗效观察[J].中国临床医学影像杂志,2017,28(4):286-290.
[13]林辉,苏香花.CT引导下125I粒子植入联合支气管动脉灌注化疗栓塞治疗晚期非小细胞肺癌的效果观察[J].中国当代医药,2017,24(5):51-54.