PTCD联合γ刀治疗胆道恶性梗阻的临床应用研究
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摘要
目的探讨PTCD和γ刀联合治疗胆道恶性梗阻的疗效。方法:回顾性分析我院2005年3月至2007年11月治疗的胆道恶性梗阻患者中,选出资料齐全的77例,分为γ刀组、PTCD组以及联合组(γ刀+PTCD)作为研究对象。观察其WHO肿瘤治疗客观效果、黄疸消退情况(TB、DB)、引流管通畅时间、肝功能(ALT、AST)、肾功能(BUN、Cr)、疼痛缓解情况、副反应、生存期。结果肿瘤变化:22例联合组中CR5例,PR13例,PD4例,总有效率(CR+PR)为81.8%。单纯γ刀组中CR6例,PR16例,总有效率(CR+PR)为73.3%。单纯PTCD组中PD25例,即肿瘤均有不同程度增长。治疗结束后1周内,联合组及PTCD组黄疸缓解率均为100%,γ刀组66.7%,治疗结束后2周内综合组、PTCD、γ刀组组黄疸消退率分别为100%、100%、60%。3个月黄疸消退率为90.9%、84%、50%、6个月黄疸消退率为81.8%、80%、0%,联合组与PTCD组黄疸缓解率比较差异不显著(P＞0.05),联合组与γ刀组比较差异有显著意义(P＜0.05),PTCD组与γ刀组比较差异有显著意义(P＜0.05)。联合组、单纯γ刀组、单纯PTCD组三组的生存时间(以治疗结束为起点,以死亡和失访时间为终点)分别为12.3±3.5个月、11.4±2.5个月、5.5±2.1个月,联合组与单纯PTCD组差异显著(P＜0.01),联合组与单纯γ组差异不显著(P=0.562),单纯γ组与单纯PTCD组差异显著(P＜0.01)。结论PTCD和γ刀联合治疗胆道恶性梗阻是一种安全、有效、并发症并不增多的有效治疗方法,值得进一步研究和推广。
Objective To evaluate the effect of PTCD(include metallic stent placement)combined with Gamma knife for management of malignant obstruction of biliary tract.Methods 77 patients with malignant obstructive were analysed,including 22 treat with PTCD combined with Gamma knife and 30 with Gamma alone and 25 with PTCD alone.The effects of turner therapy,regression of jaundice(TB,DB),patency time of drainge-tube,hepatic function(ALT,AST),kidney function(Bun,Cr),pain relief rate,side effects,survival time were observed.Results Combined therapy group's response rate(CR+PR)was 81.8%,complete remission(CR)5cases,partial remission(PR)13 cases,PD 4 cases.Gamma kinife group's response rate was 73.3%,CR 6 cases,PR 16 cases.PTCD group's PD cases was 25. Combined therapy group and PTCD group jaundice regression rate was 100%in one week after treatment,gamma knife group's jaundice regression rate was 66.7% respectively;afert two weeks of treatment,combined therapy group,PTCD group,gamma group's jaundice regression rate was 100%,100%,60%respectively; alert three months of treatment,combined therapy group,PTCD group,gamma group's jaundice regression rate was 90.9%,84%,50%respectively;afert six months of treatment,combined therapy group,PTCD group,gamma group's jaundice regression rate was 81.8%,80%,0%respectively.The survival time of combined therapy group,PYCD group,gamma group was 12.3±3.5 months,11.4±2.5 months,5.5±2.1 months respectively,give a significant difference between combined group and PTCD group,gamma group and PTCD group(P＜0.05).Conelusion PTCD combined with Gamma knife is more effective to the PTCD alone and Gamma alone.
Objective To evaluate the effect of PTCD(include metallic stent placement)combined with Gamma knife for management of malignant obstruction of biliary tract.Methods 77 patients with malignant obstructive were analysed,including 22 treat with PTCD combined with Gamma knife and 30 with Gamma alone and 25 with PTCD alone.The effects of turner therapy,regression of jaundice(TB,DB),patency time of drainge-tube,hepatic function(ALT,AST),kidney function(Bun,Cr),pain relief rate,side effects,survival time were observed.Results Combined therapy group's response rate(CR+PR)was 81.8%,complete remission(CR)5cases,partial remission(PR)13 cases,PD 4 cases.Gamma kinife group's response rate was 73.3%,CR 6 cases,PR 16 cases.PTCD group's PD cases was 25. Combined therapy group and PTCD group jaundice regression rate was 100%in one week after treatment,gamma knife group's jaundice regression rate was 66.7% respectively;afert two weeks of treatment,combined therapy group,PTCD group,gamma group's jaundice regression rate was 100%,100%,60%respectively; alert three months of treatment,combined therapy group,PTCD group,gamma group's jaundice regression rate was 90.9%,84%,50%respectively;afert six months of treatment,combined therapy group,PTCD group,gamma group's jaundice regression rate was 81.8%,80%,0%respectively.The survival time of combined therapy group,PYCD group,gamma group was 12.3±3.5 months,11.4±2.5 months,5.5±2.1 months respectively,give a significant difference between combined group and PTCD group,gamma group and PTCD group(P＜0.05).Conelusion PTCD combined with Gamma knife is more effective to the PTCD alone and Gamma alone.
引文
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3.谢立铎.T管内引流治疗恶性梗阻性黄疸9例疗效观察.河北医药,2000,22:46.
4.杨树林,姜喜远,王凯民,等.肝总管-十二指肠架桥内引流治疗梗阻性黄疸.中华肝胆外科杂志,2003,9:94.
5.张福君,吴沛宏,黄金华,等.第五届全国介入放射学学术大会讨论文集[C].西安,2002,489-491.
6.Lawrence TS,Tesser RJ,Ten Haken RK.An applicarion of dose volume histograms to ghe ireatment of intraheparic malignancies with radiation therapy[J].Int J Radiat Oncol Biol Phys,1990,19(4):1041-1047.
7.陈元,等.肝脏肿瘤立体定向放疗的近期疗效.同济医科大学学报,2000,29:578-580。
8.申泓,肖思洁,全身伽玛刀治疗癌性梗阻性黄疸临床疗效观察[J],中国厂矿医学,2204,17(2):99.
9.傅尚志,张楚毅,张景源.电离辐射对肝脏的伤[J].国外医学.放射医学核医学分册,1997(21)4:188-191.
10.王迎选,王所亭.现代立体放射治疗学,人民军医出版社,1999:101。
11.任本,宋江波,张芬琴等.定向放射治疗胰腺癌206例.云南省立体定向放射技术暨伽玛刀临床应用学术讨论会论文汇编,2005:102-103.
12.李明科.经皮肝穿刺胆道造影对恶性梗阻性黄疸病因诊断价值的探讨.肿瘤,1994;14(3)159.
13.Diamond T,Row Lands BJ.Endotoxacemia in obstructive jaundice[J].Hpb Sury,1991,4:81.
14.唐汉军,李宏斌,胰腺癌全身伽玛刀治疗后近期疗效观察[J];临床肿瘤学杂志;2002年01期;50-51.
15.Clements MD,Mccaigue M,Erwin P,et al.Biliary decompression promote Kupffer cell recovery in obstructive jaundice[J].Gut,1996,38(6):925.
16.杨忠,耿小平。阻塞性黄疸大鼠胆总管直径、压力及血清胆红素代谢变化的观察[J].肝胆外科杂志,2003,11(2):141.
17.蒋飞照,屠金夫,黄秀芳,等.梗阻性黄疸大鼠可溶性与肝肾功能改变的关系[J].月邗旦外科杂志,2004,12(2):88.
18.汲崇德,李颖,李再福,等.梗阻性黄疸超微结构改变机制[J].中国实验设计,2006,10(4).402-404.
19.郑泽霖,孙立波.梗阻性黄疸的介入治疗[J].肝胆外科杂志.2003,4(11)89-90.
20.Baijal SS,Dhiman RK,Gupta S,et al.Percutaneous transhepatic biliary drainage in the management of obstructive jaundice[J].Trop Gastroentero.1997,18(1):167-171.
21.封光华,蔡阳,杨德琪,等.经皮肝穿发道内外引流术治疗恶性梗阻性黄疸[J].临床外科杂志 2002,10(5):270-271.
22.施海斌,李麟荪,徐泽宽,等.经皮胆道引流术治疗恶性梗阻性黄疸[J].介入放射学杂志,2001,10(5):292-295.
23.Yoshioka T,Sakaguchi H,Yoshimura H,et al.Expandable metallic biliary endoprosthesesa preliminary clinical evaluation[J].Radiology1990,177(2):253-257.
24.Lammer J,Hausegger KA,Fluckiger F,et al.Common bile duct obstruction due to malignancy treatment with plastic versus metal stents[J].Radiology,1996,202(1):167-172.
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