艾迪联合碘-125粒子胆道腔内放疗治疗恶性梗阻性黄疸的临床研究
|
摘要
背景
大部分恶性梗阻性黄疸在确诊时已失去根治性手术机会,手术切除率低。胆道支架置入术是目前首选的姑息治疗恶性梗阻性黄疸方法。但支架置入术感染率高、术后再狭窄大大影响临床疗效。肿瘤生长是造成支架堵塞、黄疸复发的主要原因。碘-125粒子是一种新型放射源,具有低剂量率、可持续照射等特点,将碘-125粒子应用于胆道腔内照射治疗,控制局部肿瘤生长,有望解决胆道支架置入后再狭窄问题。联合中医药辨证施治有望提高患者免疫力,减少感染的发生,从而提高患者对介入治疗的耐受性。
目的
观察恶性梗阻性黄疸患者介入治疗前后中医证候的变化,为恶性梗阻性黄疸围介入期的中医辨证施治提供参考;评价艾迪注射液治疗恶性黄疸气虚毒瘀证的临床疗效,验证其提高患者免疫功能、减少感染发生率的作用;探讨自制留置导管进行碘-125粒子胆道腔内准确置入的可行性;评价碘-125粒子腔内照射防治胆道支架置入术后再狭窄的临床疗效;寻找一种中西医结合治疗恶性梗阻性黄疸的最佳方案,以发现一种解决胆道支架置入术后再狭窄问题的有效手段,从而提高临床疗效。
方法
采用前瞻性非随机对照试验,观察艾迪注射液及碘-125粒子胆道腔内放疗治疗失去根治性手术机会的恶性梗阻性黄疸的临床疗效。临床观察2005年10月~2008年4月恶性梗阻性黄疸住院病人38例,治疗组(支架+粒子组)19例,对照组(单纯支架组)19例。治疗组内应用艾迪共8例,对照组内应用艾迪共11例。观察各组介入治疗前后中医证候积分、肝功能各项指标、KPS评分、CEA、感染发生率、感染持续时间、生存率、中位生存时间及无黄疸生存时间等指标。
结果
治疗组与对照组在年龄、性别构成上的差异均无统计学意义(P＞0.05)。经Fisher's确切概率检验,肿瘤类型在两组构成差异有统计学意义(P＜0.05)。
38例患者介入治疗前黄疸、腹痛、口干口苦、心烦易怒等标实证候积分显著升高,同时纳呆食少、少气懒言、乏力肢软等本虚证积分也升高;经配对t检验,介入术后1周患者上述标实证积分与术前比较有明显降低,差异有统计学意义(P＜0.05)。少气懒言、乏力肢软、腹胀等本虚证积分与术前比较有所降低,差异有统计学意义(P＜0.05);介入术后一个月各项证候积分除发热与纳呆食少外较术前均有明显降低,差异有统计学意义(P＜0.05)。
全部病例在介入治疗术后一周、一月、三月内大部分肝功能指标呈现逐渐降低的趋势。其中术后一周、一月、三月ALT、AST、TBIL、DBIL、GGT、TBA均较术前明显降低,经配对t检验,差异均有统计学意义(P＜0.05)。全部病例术后一周、一月KPS均较术前明显升高,经配对t检验分析,差异有统计学意义(P＜0.05)。全部病例中应用艾迪组发生感染例数比不用艾迪组少,感染发生率稍低,经χ~2检验,差异无统计学意义(χ~2=0.792,P=0.660)。全部病例中应用艾迪组发生感染天数比不用艾迪组短,经t检验,差异无统计学意义(P＞0.05)。
治疗组术后一周、一月、三月、六月肝功能指标ALT、AST、TBIL、DBIL、GGT、TBA均较术前降低,其中术后一周较术前明显降低,经t检验,差异有统计学意义(P＜0.05)。治疗组术后一周、一月、六月较术前明显降低,经t检验,差异有统计学意义(P＜0.05)。对照组术后一周、一月TBIL、DBIL较术前明显降低,经t检验,差异有统计学意义(P＜0.05)。但术后六月ALT、AST、TBIL、DBIL、ALP较术前升高。提示对照组术后六月出现黄疸复发。经t检验,治疗组术后一周、一月KPS较术前明显升高,差异有统计学意义(P＜0.05)。对照组术后一周KPS较术前明显升高,差异有统计学意义(P＜0.05)。
两组介入治疗术后六月肝功能各项指标比较,治疗组AST、TBIL、DBIL治疗组明显低于对照组,经t检验,差异有统计学意义(P＜0.05)。介入治疗术后六月治疗组CEA明显低于对照组,经t检验,差异有统计学意义(t=-242.88,P=0.000)。治疗组术后一周、术后一月KPS均比对照组高,经t检验,差异无统计学意义(P＞0.05)。
治疗组中位生存时间为456天,对照组中位生存时间为330天,治疗组中位生存时间比对照组长,经检验,差异有统计学意义(P＜0.05)。治疗组术后平均无黄疸生存时间为20.33月,对照组术后平均无黄疸生存时间为13月,治疗组术后无黄疸生存时间比对照组长,经秩和检验,差异有统计学意义(Z=-2.17,P=0.030)。
治疗组术后ALT、AST均较术前降低,治疗组术后WBC、BUN、Crea与术前相比。经t检验分析,差异无统计学意义(P＞0.05)。
结论
介入治疗对恶性梗阻性黄疸中医证候的传变有明显的影响。恶性梗阻性黄疸介入治疗术前本虚标实证候兼具,而以标实证候为主。介入治疗术后本虚证的矛盾相对更加突出。艾迪注射液具有降低恶性梗阻性黄疸感染发生率的作用。经皮肝穿刺胆道引流联合胆道支架置入治疗可以快速解除梗阻,恢复胆汁生理性引流,明显改善患者的肝功能。经皮肝穿刺胆道引流联合胆道支架置入治疗对恶性梗阻性黄疸近期疗效确切。应用自制留置导管进行碘-125粒子胆道腔内准确置入安全可行,碘-125粒子胆道腔内放疗可以部分控制肿瘤组织的生长,延长支架开通时间,改善肝功能,从而延长患者的生存时间。艾迪注射液联合碘-125粒子胆道腔内放疗治疗恶性梗阻性黄疸是一种较好的方案,可以提高临床疗效,延长患者生存期、改善生存质量。
Background
Most malignant obstructive jaundice are unresectable when diagnosed.The surgery ratio is low.Biliary stent implantation has already become one of the alleviative treatment of the malignant obstructive jaundice,which will effect the therapeutic efficacy,because the stent will become restenosis in some patients after the 3-6months in the clinical practice observation.The high infect rate and restenosis has seriously affected the clinical effect.There has been many tries to resolve the Stent' s restenosis.However to this day,no effective method has been discovered.The tumor' s growth is the major reason to the restenosis.Positive treatments to the primary tumor are required.It' s crucial to raise the forward effect.I-125 seeds which were made in China recently has the characteristic of low dose rate and persistent irradiation, which can redeem the insufficiency of the irradiation and be the permanent radiation source.It is hoped to decrease the restenosis of the stent by applying the I-125 seeds in the bile duct.The unite use of TCM can raise the patient' s immunity and reduce the infect rate,and can raise the patient' s toleration to intervention.
Purpose
To observe the TCM zhenghou' s change in the front and the back of the intervention and instruct the TCM diagnosis and treatment.To evaluate the effect of the aidi injection in treatment of the malignant jaundice with deficiency of vital energy,poison and blood stasis syndrom.To evaluate the effect of the aidi injection' s in raising the patient' s immunity and reduce the infect rate.To evaluate the feasibility of the applying the I-125 seeds in the bile duct with home-made catheter.To evaluate the effect of the I-125 seeds in the bile duct to prevent and cure the Stent' s restenosis.To find the best Chinese and Western Medicine solution to treat the malignant obstructive jaundice.To find an effective solution to resolve the Stent' s restenosis and raise the effect,extend the patient' s lifetime,improve the patient' s Quality of Life.
Method
We use control experiment,Prospective Trial.There are thirty eight malignant obstructive jaundice patients in hospital 10th,2005-4th,2008.We put the 19 cases into the treatment group(biliary stent implantation + intraluminal brachytherapy by I-125 seeds) and another 19 cases into the antitheses group(biliary stent implantation).8 cases in the treatment group and 11 cases in the antitheses group use aidi injection.And to valuate the TCM zhenghou' s change,liver function,KPS score,CEA,the infect rate,the infect duration,survival rate and median survival time in the two group in the front and the back of the intervention.
Result
All the patient' s jaundice,abdominal pain,feel thirsty and bitter,be disturbed and fretful Score are soar before the intervention.And the above-mentioned Biaoshi syndrome reduce one week after the intervention.The differents have statistics significance(P＜0.05).The Benxu syndrome such as short of breath,don' t want talk,out of strength,abdominal distension reduce after the intervention.The differents have statistics significance(P＜0.05).All the syndrome except fever and loss of appetite reduce than before the intervention.The differents have statistics significance(P＜0.05).The aidi injection group has a lower infection and shorter infect duration than the other group.The differents haven' t statistics significance(P＞0.05).All the patient' s liver function change smaller one week,one month,three month after the intervention than before the intervention.ALT、AST、TBIL、DBIL、GGT、TBA are smaller one week,one month,three month after the intervention than before the intervention.The differents have statistics significance(P＜0.05).KPS increase one week,one month after the intervention.The differents have statistics significance(P＜0.05).The patient' s liver function such as ALT、AST、TBIL、DBIL、GGT、TBA change smaller in the treatment group one week,one month,three month,six month after the intervention than before the intervention,one week after the intervention change smaller obviously.TBIL、DBIL in the treatment group are smaller one week,one month,three month,six month after the intervention than before the intervention.There are obviously smaller one week,one month,six month after the intervention than before the intervention.The differents have statistics significance(P＜0.05).The liver function change smaller in the antitheses group one week,one month,three month after the intervention than before the intervention.TBIL、DBIL in the antitheses group are smaller one week,one month after the intervention than before the intervention.The differents have statistics significance(P＜0.05).But ALT、AST、TBIL、DBIL、ALP increase six month after the intervention than before the intervention.It remind that the jaundice in the antitheses group recur six month after the intervention.ALT、AST、TBIL、DBIL、GGT、TBA、ALP in the treatment group are smaller than that of the antitheses group six month after the intervention.AST、TBIL、DBIL in the treatment group are seriously smaller than that of the antitheses group. The differents haven' t statistics significance(P＞0.05).KPS increace one week,one month after the intervention than before the intervention in the two groups.KPS in the treatment group increace seriously one week,one month after the intervention than before the intervention.The differents have statistics significance(P＜0.05).KPS in the antitheses group increace seriously one week after the intervention than before the intervention.The differents have statistics significance(P＜0.05).KPS in the treatment group is more than that of the antitheses group one week,one month after the intervention.The differents have statistics significance(P＜0.05).CEA in the treatment group is seriously smaller than that of the antitheses group six month after the intervention.The differents have statistics significance(P＜0.05).The counts without jaundice in the treatment group are more than that of the antitheses group when the patient die or the last correspondence.The differents have statistics significance(P＜0.05).The median survival time of the treatment group is 456 days.The median survival time of the antitheses group is 330 days.The median survival time of the treatment group is longer than that of the antitheses group.The differents have statistics significance(P＜0.05). The median survival time of the pancreatic cancer IS the longest in the treatment group,it' s 690 days.And the shortest is the carcinoma of gallbladder,.it' s 60 days.The differents in different carcinoma type haven' t statistics significance(P＞0.05).The median survival time of the carcinoma of bile duct IS the longest in the antitheses group,it' s 330 days.And the shortest is the pancreatic cancer,.it' s 165 days.The differents in different carcinoma type haven' t statistics significance in the antitheses group(P＞0.05).ALT、AST in the treatment group change smaller after the intervention than before the intervention.WBC、BUN、Crea in the treatment group after the intervention haven' t differents than that before the intervention.The differents in different carcinoma type haven' t statistics significance(P＞0.05).
Conclusion
The Intervention has seriously effect to the TCM zhenghou' s in the malignant obstructive jaundice.Before the Intervention there are Benxu and Biaoshi syndromes,and the Biaoshi syndromes are major.After the Intervention Benxu syndromes are noticeable.Aidi injection can reduce the infect rate of the malignant obstructive jaundice.PTCD combined with Billary stent can get rid of the obstruction,recover the physiologic drainage of the bile, improve the liver function.PTCD combined with Billary stent have precise effection in the treatment of the malignant obstructive jaundice.It' s feasible to apply the I-125 seeds in the bile duct with home-made catheter. I-125 seeds in the bile duct can inhibit the grouth of the tumor tissue,extend the time of the stent keep smooth,,improve the liver function,extend the survival time of the patients.
大部分恶性梗阻性黄疸在确诊时已失去根治性手术机会,手术切除率低。胆道支架置入术是目前首选的姑息治疗恶性梗阻性黄疸方法。但支架置入术感染率高、术后再狭窄大大影响临床疗效。肿瘤生长是造成支架堵塞、黄疸复发的主要原因。碘-125粒子是一种新型放射源,具有低剂量率、可持续照射等特点,将碘-125粒子应用于胆道腔内照射治疗,控制局部肿瘤生长,有望解决胆道支架置入后再狭窄问题。联合中医药辨证施治有望提高患者免疫力,减少感染的发生,从而提高患者对介入治疗的耐受性。
目的
观察恶性梗阻性黄疸患者介入治疗前后中医证候的变化,为恶性梗阻性黄疸围介入期的中医辨证施治提供参考;评价艾迪注射液治疗恶性黄疸气虚毒瘀证的临床疗效,验证其提高患者免疫功能、减少感染发生率的作用;探讨自制留置导管进行碘-125粒子胆道腔内准确置入的可行性;评价碘-125粒子腔内照射防治胆道支架置入术后再狭窄的临床疗效;寻找一种中西医结合治疗恶性梗阻性黄疸的最佳方案,以发现一种解决胆道支架置入术后再狭窄问题的有效手段,从而提高临床疗效。
方法
采用前瞻性非随机对照试验,观察艾迪注射液及碘-125粒子胆道腔内放疗治疗失去根治性手术机会的恶性梗阻性黄疸的临床疗效。临床观察2005年10月~2008年4月恶性梗阻性黄疸住院病人38例,治疗组(支架+粒子组)19例,对照组(单纯支架组)19例。治疗组内应用艾迪共8例,对照组内应用艾迪共11例。观察各组介入治疗前后中医证候积分、肝功能各项指标、KPS评分、CEA、感染发生率、感染持续时间、生存率、中位生存时间及无黄疸生存时间等指标。
结果
治疗组与对照组在年龄、性别构成上的差异均无统计学意义(P＞0.05)。经Fisher's确切概率检验,肿瘤类型在两组构成差异有统计学意义(P＜0.05)。
38例患者介入治疗前黄疸、腹痛、口干口苦、心烦易怒等标实证候积分显著升高,同时纳呆食少、少气懒言、乏力肢软等本虚证积分也升高;经配对t检验,介入术后1周患者上述标实证积分与术前比较有明显降低,差异有统计学意义(P＜0.05)。少气懒言、乏力肢软、腹胀等本虚证积分与术前比较有所降低,差异有统计学意义(P＜0.05);介入术后一个月各项证候积分除发热与纳呆食少外较术前均有明显降低,差异有统计学意义(P＜0.05)。
全部病例在介入治疗术后一周、一月、三月内大部分肝功能指标呈现逐渐降低的趋势。其中术后一周、一月、三月ALT、AST、TBIL、DBIL、GGT、TBA均较术前明显降低,经配对t检验,差异均有统计学意义(P＜0.05)。全部病例术后一周、一月KPS均较术前明显升高,经配对t检验分析,差异有统计学意义(P＜0.05)。全部病例中应用艾迪组发生感染例数比不用艾迪组少,感染发生率稍低,经χ~2检验,差异无统计学意义(χ~2=0.792,P=0.660)。全部病例中应用艾迪组发生感染天数比不用艾迪组短,经t检验,差异无统计学意义(P＞0.05)。
治疗组术后一周、一月、三月、六月肝功能指标ALT、AST、TBIL、DBIL、GGT、TBA均较术前降低,其中术后一周较术前明显降低,经t检验,差异有统计学意义(P＜0.05)。治疗组术后一周、一月、六月较术前明显降低,经t检验,差异有统计学意义(P＜0.05)。对照组术后一周、一月TBIL、DBIL较术前明显降低,经t检验,差异有统计学意义(P＜0.05)。但术后六月ALT、AST、TBIL、DBIL、ALP较术前升高。提示对照组术后六月出现黄疸复发。经t检验,治疗组术后一周、一月KPS较术前明显升高,差异有统计学意义(P＜0.05)。对照组术后一周KPS较术前明显升高,差异有统计学意义(P＜0.05)。
两组介入治疗术后六月肝功能各项指标比较,治疗组AST、TBIL、DBIL治疗组明显低于对照组,经t检验,差异有统计学意义(P＜0.05)。介入治疗术后六月治疗组CEA明显低于对照组,经t检验,差异有统计学意义(t=-242.88,P=0.000)。治疗组术后一周、术后一月KPS均比对照组高,经t检验,差异无统计学意义(P＞0.05)。
治疗组中位生存时间为456天,对照组中位生存时间为330天,治疗组中位生存时间比对照组长,经检验,差异有统计学意义(P＜0.05)。治疗组术后平均无黄疸生存时间为20.33月,对照组术后平均无黄疸生存时间为13月,治疗组术后无黄疸生存时间比对照组长,经秩和检验,差异有统计学意义(Z=-2.17,P=0.030)。
治疗组术后ALT、AST均较术前降低,治疗组术后WBC、BUN、Crea与术前相比。经t检验分析,差异无统计学意义(P＞0.05)。
结论
介入治疗对恶性梗阻性黄疸中医证候的传变有明显的影响。恶性梗阻性黄疸介入治疗术前本虚标实证候兼具,而以标实证候为主。介入治疗术后本虚证的矛盾相对更加突出。艾迪注射液具有降低恶性梗阻性黄疸感染发生率的作用。经皮肝穿刺胆道引流联合胆道支架置入治疗可以快速解除梗阻,恢复胆汁生理性引流,明显改善患者的肝功能。经皮肝穿刺胆道引流联合胆道支架置入治疗对恶性梗阻性黄疸近期疗效确切。应用自制留置导管进行碘-125粒子胆道腔内准确置入安全可行,碘-125粒子胆道腔内放疗可以部分控制肿瘤组织的生长,延长支架开通时间,改善肝功能,从而延长患者的生存时间。艾迪注射液联合碘-125粒子胆道腔内放疗治疗恶性梗阻性黄疸是一种较好的方案,可以提高临床疗效,延长患者生存期、改善生存质量。
Background
Most malignant obstructive jaundice are unresectable when diagnosed.The surgery ratio is low.Biliary stent implantation has already become one of the alleviative treatment of the malignant obstructive jaundice,which will effect the therapeutic efficacy,because the stent will become restenosis in some patients after the 3-6months in the clinical practice observation.The high infect rate and restenosis has seriously affected the clinical effect.There has been many tries to resolve the Stent' s restenosis.However to this day,no effective method has been discovered.The tumor' s growth is the major reason to the restenosis.Positive treatments to the primary tumor are required.It' s crucial to raise the forward effect.I-125 seeds which were made in China recently has the characteristic of low dose rate and persistent irradiation, which can redeem the insufficiency of the irradiation and be the permanent radiation source.It is hoped to decrease the restenosis of the stent by applying the I-125 seeds in the bile duct.The unite use of TCM can raise the patient' s immunity and reduce the infect rate,and can raise the patient' s toleration to intervention.
Purpose
To observe the TCM zhenghou' s change in the front and the back of the intervention and instruct the TCM diagnosis and treatment.To evaluate the effect of the aidi injection in treatment of the malignant jaundice with deficiency of vital energy,poison and blood stasis syndrom.To evaluate the effect of the aidi injection' s in raising the patient' s immunity and reduce the infect rate.To evaluate the feasibility of the applying the I-125 seeds in the bile duct with home-made catheter.To evaluate the effect of the I-125 seeds in the bile duct to prevent and cure the Stent' s restenosis.To find the best Chinese and Western Medicine solution to treat the malignant obstructive jaundice.To find an effective solution to resolve the Stent' s restenosis and raise the effect,extend the patient' s lifetime,improve the patient' s Quality of Life.
Method
We use control experiment,Prospective Trial.There are thirty eight malignant obstructive jaundice patients in hospital 10th,2005-4th,2008.We put the 19 cases into the treatment group(biliary stent implantation + intraluminal brachytherapy by I-125 seeds) and another 19 cases into the antitheses group(biliary stent implantation).8 cases in the treatment group and 11 cases in the antitheses group use aidi injection.And to valuate the TCM zhenghou' s change,liver function,KPS score,CEA,the infect rate,the infect duration,survival rate and median survival time in the two group in the front and the back of the intervention.
Result
All the patient' s jaundice,abdominal pain,feel thirsty and bitter,be disturbed and fretful Score are soar before the intervention.And the above-mentioned Biaoshi syndrome reduce one week after the intervention.The differents have statistics significance(P＜0.05).The Benxu syndrome such as short of breath,don' t want talk,out of strength,abdominal distension reduce after the intervention.The differents have statistics significance(P＜0.05).All the syndrome except fever and loss of appetite reduce than before the intervention.The differents have statistics significance(P＜0.05).The aidi injection group has a lower infection and shorter infect duration than the other group.The differents haven' t statistics significance(P＞0.05).All the patient' s liver function change smaller one week,one month,three month after the intervention than before the intervention.ALT、AST、TBIL、DBIL、GGT、TBA are smaller one week,one month,three month after the intervention than before the intervention.The differents have statistics significance(P＜0.05).KPS increase one week,one month after the intervention.The differents have statistics significance(P＜0.05).The patient' s liver function such as ALT、AST、TBIL、DBIL、GGT、TBA change smaller in the treatment group one week,one month,three month,six month after the intervention than before the intervention,one week after the intervention change smaller obviously.TBIL、DBIL in the treatment group are smaller one week,one month,three month,six month after the intervention than before the intervention.There are obviously smaller one week,one month,six month after the intervention than before the intervention.The differents have statistics significance(P＜0.05).The liver function change smaller in the antitheses group one week,one month,three month after the intervention than before the intervention.TBIL、DBIL in the antitheses group are smaller one week,one month after the intervention than before the intervention.The differents have statistics significance(P＜0.05).But ALT、AST、TBIL、DBIL、ALP increase six month after the intervention than before the intervention.It remind that the jaundice in the antitheses group recur six month after the intervention.ALT、AST、TBIL、DBIL、GGT、TBA、ALP in the treatment group are smaller than that of the antitheses group six month after the intervention.AST、TBIL、DBIL in the treatment group are seriously smaller than that of the antitheses group. The differents haven' t statistics significance(P＞0.05).KPS increace one week,one month after the intervention than before the intervention in the two groups.KPS in the treatment group increace seriously one week,one month after the intervention than before the intervention.The differents have statistics significance(P＜0.05).KPS in the antitheses group increace seriously one week after the intervention than before the intervention.The differents have statistics significance(P＜0.05).KPS in the treatment group is more than that of the antitheses group one week,one month after the intervention.The differents have statistics significance(P＜0.05).CEA in the treatment group is seriously smaller than that of the antitheses group six month after the intervention.The differents have statistics significance(P＜0.05).The counts without jaundice in the treatment group are more than that of the antitheses group when the patient die or the last correspondence.The differents have statistics significance(P＜0.05).The median survival time of the treatment group is 456 days.The median survival time of the antitheses group is 330 days.The median survival time of the treatment group is longer than that of the antitheses group.The differents have statistics significance(P＜0.05). The median survival time of the pancreatic cancer IS the longest in the treatment group,it' s 690 days.And the shortest is the carcinoma of gallbladder,.it' s 60 days.The differents in different carcinoma type haven' t statistics significance(P＞0.05).The median survival time of the carcinoma of bile duct IS the longest in the antitheses group,it' s 330 days.And the shortest is the pancreatic cancer,.it' s 165 days.The differents in different carcinoma type haven' t statistics significance in the antitheses group(P＞0.05).ALT、AST in the treatment group change smaller after the intervention than before the intervention.WBC、BUN、Crea in the treatment group after the intervention haven' t differents than that before the intervention.The differents in different carcinoma type haven' t statistics significance(P＞0.05).
Conclusion
The Intervention has seriously effect to the TCM zhenghou' s in the malignant obstructive jaundice.Before the Intervention there are Benxu and Biaoshi syndromes,and the Biaoshi syndromes are major.After the Intervention Benxu syndromes are noticeable.Aidi injection can reduce the infect rate of the malignant obstructive jaundice.PTCD combined with Billary stent can get rid of the obstruction,recover the physiologic drainage of the bile, improve the liver function.PTCD combined with Billary stent have precise effection in the treatment of the malignant obstructive jaundice.It' s feasible to apply the I-125 seeds in the bile duct with home-made catheter. I-125 seeds in the bile duct can inhibit the grouth of the tumor tissue,extend the time of the stent keep smooth,,improve the liver function,extend the survival time of the patients.
引文
[1]刘祥俊.中西医结合治疗胆石梗阻性黄疸33例分析[J].中国误诊学杂志,2007,14(7):3439-3400.
[2]汪达成.梗阻性黄疸的中医中药治疗[J].苏州医学,2002,25(2):68-69.
[3]王波,余牧钦.中西结合治疗胆石所致梗阻性黄疸43例分析[J].贵阳中医学院学报,1997,19(2):25-26.
[4]黄坚,谢建光.中西医结合治疗原发性胆道狭窄梗阻性黄疸[J].新中医,1999,7:16-17.
[5]吴尘轩,丁守成.茵陈蒿汤用于梗阻性黄疸术后减黄的疗效观察[J].中国中西医结合外科杂志,2001,4(7):265-266.
[6]曹仕兵,颜开明.中西医结合治疗高龄胆石梗阻性黄疸56例[J].现代中西医结合杂志,2002,20(11):2024-2025.
[7]陈维昌.中西医结合治疗梗阻性黄疸31例临床体会[J].中华临床医学研究杂志,2003,72:11998-11999.
[8]欧颖.退黄散治疗肝内梗阻性黄疸70例[J].现代中西医结合杂志,2007,1:94-95.
[9]钱爱军,金庆丰.利胆消炎汤治疗梗阻性黄疸38例[J].中国中西医结合外科杂志,1998,2:121.
[10]林冬岩,张学武.漏芦对梗阻性黄疸大鼠肝损伤的形态学研究[J],时珍国医国药,2006,2(17):213-214.
[11]成志刚,胡志前.中药合剂调节梗阻性黄疸大鼠细胞免疫功能的实验研究[J].中国中西医消化杂志,2002,4(10):225-227.
[12]徐斌.中药对梗阻性黄疸患者术后细胞免疫功能的调节[J].辽宁中医杂志,2007,34(6):712-713.
[13]巩涛,曹月敏等.大柴胡汤加昧对梗阻性黄疸患者血T细胞亚群和肿瘤坏死因子的影响[J].中国中西医结合杂志,1997,11:660-662.
[14]孙静文,张伟.中药对梗阻性黄疸患者术后免疫调节的研究[J].陕西中医,2006,27(1):14-15.
[15]张孟增(主编),张金山(主审).介入放射学基础与临床,北京:中国科学技术出版社,2001,5.
[16]董家鸿,曾永毅.梗阻性黄疸减黄研究热点与难点[J].中国实用外科杂志,2007,10(27):768.769.
[17]钟守先.积极开展胰头癌根治术为提高五年生存率而努力.中华肝胆外科杂志,1998.4.267
[18]Giovanni D.Palma D,Galloro,et al.Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction:result of prospective,randomized,and control study.Gastrointestinal Endoscopy,2001;53:547.
[19]Soulez G,Gagner M,Therasme E,et al.Malignant biliary obstruction:preliminary result of palliative treatment with hepaticogastrostomy under fluroscopic,endoscopic,and laparoscopic guidance.Radiology,1994;192:2411.
[20]Shinchi H,Takao S,Nishida H,et al.Length and Quality of Sunival Following External Beam Radiotherapy Conhined with Expandabe Metallic Stent for Unresectable Hilar Cholangio-carcinomal,[J].J Surg Oncol,2000,75(2):89-94.
[21]Irving J,Adam A,Dick R,et al.Gianturco expandable metallic biliary stents:results of a European clinical trial.Radiology,1989;172:321.
[22]Lammer J,KIeinert R,hauseggerK,et al.Obstructlve Jaundice:use of expandable metal endoprosthese for biliary drainage Radiology,1990,177:789.
[23]高健,杜湘珂,金龙,等.自膨胀式支架在梗阻性黄疸治疗中的应用[J].中国医学影像技术,2002,18:419-421.
[24]Lammer J,Hauseggcr KA,Fluckigcr F,et al.Common bile duct obstruction due to malignancy:treatment with plastic versus meta / Stents,Radiology,1996;201(1):167-172.
[25]金龙,高健,陈雷,等.应用自膨式金属支架姑息治疗无法手术的恶性梗阻性黄疸.中国医学影像技术,2008,24(11):1825-1828.
[26]刘福全,岳振东,冯铁红,等.胆道支架置入术治疗胆道恶性梗阻.中国肿瘤临床,2004;31(2):86-88.
[27]曹广,杨仁杰.金属支架姑息治疗恶性梗阻性黄疸的术后随访及生存分析.北京大学学报(医学版),2008,40(2):121-124.
[28]Esehelman DJ,Shapiro MJ,Bonn J,et al.Malignant biliary ductobstruction:longer-term experience with giantureo stents and combined modality radiation therapy.Radiology,1996,200:717.724.
[29]Isayama H,Komatsu Y,Tsujino T,et al.A prospective randomized study of "covered" versus "uncovered" diamond stents for the manage-ment of distal malignant biliary obstruction[J].Gut,2004,53:729-734.
[30]Leung J,Rahim N.The role of covered self-expandable mentallic stents in malignant biliary strictures.Gastrointest Endosc,2006,68(7):1001-1003.
[31]Bethge N,Wagner HJ,Knyrim K,et al,technical failure of biliary metal stent deployment in a series of 116 applications[J].Endoscopy,1992,24:395.
[32]王建华,王小林,颜志平.腹部介入放射学.上海:上海医科大学出版社.1998.113.
[33]王小林,董永华,龚高全.恶性梗阻性黄疸的双介入治疗.介入放射学杂志,1998,4,207.
[34]陈颐,王小林,王建华,等.胆道支架置放结合动脉化疗栓塞治疗恶性梗阻性黄疸.复旦学报(医学科学版),2001,28(6):516-518.
[35]甄彦利,马和平,张学军,等.恶性梗阻性黄疸的双介入治疗.内蒙古医学杂志,2006,38(3):211-212.
[36]王琼瑶,谢其根,杨章庚,等.)金属胆道支架置入联合介入化疗治疗恶性梗阻性黄疸的疗效.现代肿瘤医学,2006,14(5):587-588.
[37]丁田贵,尹立杰,高众等,胆道介入支架联合立体定向放射治疗恶性梗阻性黄疸.中华放射医学与防护杂志,2006(26):265-266.
[38]张骏,高宏,李力军.超声引导射频消融联合125I粒子置入治疗进展期胰腺癌.山东医药,2008,48(27):104-105.
[39]崔忠,杜冬,王振全,等.多极射频消融治疗不能切除胰腺癌的临床应用研究.华北国防医药,2008;20(5):7-9。
[40]张啸,张筱凤,杨建锋.经内镜射频消融和置人内支架联合治疗不能切除的胆胰肿瘤.中华消化内镜杂志.2006,23(4):252-255。
[41]范卫君,吴沛宏,张亮,等.Ⅲ、Ⅳ型肝门区胆管腺癌的介入治疗.中华放射学杂志,2005,39(9):925-929.
[42]吕民生,余昌中,宋丽霞.腔内放疗在恶性梗阻性黄疸治疗中的应用.中华现代外科学杂志,2007,4(6):416-417.
[43]Bruha R,Petrtyl J,Kubecova M,et al.Intraluminal brachytherapy and serf -expan dable stents in nonresectable biliary ma lign ancies- the question of long-term palliation.Hepatogastroenterology,2001,48(39):631-637.
[44]马军,常则灵,王秀兰,等.经导管192Ir近距离放射治疗局部晚期肝门部胆管癌[J].中国肿瘤临床,1998,26(8):568-569.
[45]谢大业,刘忠,胡国平,等.胰、胆、肝区癌组织间放射治疗[J].肝胆胰外科杂志,2002,14:142.
[46]文黎明,王洪州,黄春.记忆合金支架捆绑125-碘粒子在治疗食管癌狭窄中的临床应用,中华消化内镜杂志,2004;21(6):410-411.
[47]Joyce F,Burcharth F,Holm HH.Ultrasonically guided percutaneous implantation of iodine-125 seeds in pancreatic carcinoma.Int J Radiat Oncol BM Phys.1990,19:1049-1052.
[48]王雁飞,付逢吉,徐敏等.125I放射性粒子置入联合内引流术治疗恶性梗阻性黄疸20例疗效观察.山东医药,2007;47(20):15。
[49]张惠洁,宋志春,郭卫东.125I粒子种置治疗胆总管癌1例.包头医学院学报,2004;20(3):233.
[50]李启东,姚力,贾振庚.125I放射粒子治疗中晚期胰腺癌23例临床分析中国煤炭工业医学杂志,2005;8(6):561-562.
[51]李文靖,韩伟,陈军.放射性125I粒子置入联合健择顺铂动脉灌注治疗晚期胰腺癌.广西医学,2004;26(10):1455-1456.
[52]杜学明,许建辉,郎建华,等.多学科技术联合125I治疗癌梗阻性黄疸.介入放射学杂志,2008,17(5):346-348.
[53]丛辉,刘惠萍,王耀明.放射性粒子置入治疗恶性梗阻性黄疸.中华腹部疾病杂志,2006,6(10):721-722.
[54]罗开元,李波.125I粒子组织间放射治疗恶性肿瘤的临床应用.中华医学杂志,2001:81(12):754-755.
[55]靳大勇,倪晓凌,楼文辉.125I内放射粒子置入术治疗晚期胰头癌.外科理论与实践,2002;7(5):381-382.
[2]汪达成.梗阻性黄疸的中医中药治疗[J].苏州医学,2002,25(2):68-69.
[3]王波,余牧钦.中西结合治疗胆石所致梗阻性黄疸43例分析[J].贵阳中医学院学报,1997,19(2):25-26.
[4]黄坚,谢建光.中西医结合治疗原发性胆道狭窄梗阻性黄疸[J].新中医,1999,7:16-17.
[5]吴尘轩,丁守成.茵陈蒿汤用于梗阻性黄疸术后减黄的疗效观察[J].中国中西医结合外科杂志,2001,4(7):265-266.
[6]曹仕兵,颜开明.中西医结合治疗高龄胆石梗阻性黄疸56例[J].现代中西医结合杂志,2002,20(11):2024-2025.
[7]陈维昌.中西医结合治疗梗阻性黄疸31例临床体会[J].中华临床医学研究杂志,2003,72:11998-11999.
[8]欧颖.退黄散治疗肝内梗阻性黄疸70例[J].现代中西医结合杂志,2007,1:94-95.
[9]钱爱军,金庆丰.利胆消炎汤治疗梗阻性黄疸38例[J].中国中西医结合外科杂志,1998,2:121.
[10]林冬岩,张学武.漏芦对梗阻性黄疸大鼠肝损伤的形态学研究[J],时珍国医国药,2006,2(17):213-214.
[11]成志刚,胡志前.中药合剂调节梗阻性黄疸大鼠细胞免疫功能的实验研究[J].中国中西医消化杂志,2002,4(10):225-227.
[12]徐斌.中药对梗阻性黄疸患者术后细胞免疫功能的调节[J].辽宁中医杂志,2007,34(6):712-713.
[13]巩涛,曹月敏等.大柴胡汤加昧对梗阻性黄疸患者血T细胞亚群和肿瘤坏死因子的影响[J].中国中西医结合杂志,1997,11:660-662.
[14]孙静文,张伟.中药对梗阻性黄疸患者术后免疫调节的研究[J].陕西中医,2006,27(1):14-15.
[15]张孟增(主编),张金山(主审).介入放射学基础与临床,北京:中国科学技术出版社,2001,5.
[16]董家鸿,曾永毅.梗阻性黄疸减黄研究热点与难点[J].中国实用外科杂志,2007,10(27):768.769.
[17]钟守先.积极开展胰头癌根治术为提高五年生存率而努力.中华肝胆外科杂志,1998.4.267
[18]Giovanni D.Palma D,Galloro,et al.Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction:result of prospective,randomized,and control study.Gastrointestinal Endoscopy,2001;53:547.
[19]Soulez G,Gagner M,Therasme E,et al.Malignant biliary obstruction:preliminary result of palliative treatment with hepaticogastrostomy under fluroscopic,endoscopic,and laparoscopic guidance.Radiology,1994;192:2411.
[20]Shinchi H,Takao S,Nishida H,et al.Length and Quality of Sunival Following External Beam Radiotherapy Conhined with Expandabe Metallic Stent for Unresectable Hilar Cholangio-carcinomal,[J].J Surg Oncol,2000,75(2):89-94.
[21]Irving J,Adam A,Dick R,et al.Gianturco expandable metallic biliary stents:results of a European clinical trial.Radiology,1989;172:321.
[22]Lammer J,KIeinert R,hauseggerK,et al.Obstructlve Jaundice:use of expandable metal endoprosthese for biliary drainage Radiology,1990,177:789.
[23]高健,杜湘珂,金龙,等.自膨胀式支架在梗阻性黄疸治疗中的应用[J].中国医学影像技术,2002,18:419-421.
[24]Lammer J,Hauseggcr KA,Fluckigcr F,et al.Common bile duct obstruction due to malignancy:treatment with plastic versus meta / Stents,Radiology,1996;201(1):167-172.
[25]金龙,高健,陈雷,等.应用自膨式金属支架姑息治疗无法手术的恶性梗阻性黄疸.中国医学影像技术,2008,24(11):1825-1828.
[26]刘福全,岳振东,冯铁红,等.胆道支架置入术治疗胆道恶性梗阻.中国肿瘤临床,2004;31(2):86-88.
[27]曹广,杨仁杰.金属支架姑息治疗恶性梗阻性黄疸的术后随访及生存分析.北京大学学报(医学版),2008,40(2):121-124.
[28]Esehelman DJ,Shapiro MJ,Bonn J,et al.Malignant biliary ductobstruction:longer-term experience with giantureo stents and combined modality radiation therapy.Radiology,1996,200:717.724.
[29]Isayama H,Komatsu Y,Tsujino T,et al.A prospective randomized study of "covered" versus "uncovered" diamond stents for the manage-ment of distal malignant biliary obstruction[J].Gut,2004,53:729-734.
[30]Leung J,Rahim N.The role of covered self-expandable mentallic stents in malignant biliary strictures.Gastrointest Endosc,2006,68(7):1001-1003.
[31]Bethge N,Wagner HJ,Knyrim K,et al,technical failure of biliary metal stent deployment in a series of 116 applications[J].Endoscopy,1992,24:395.
[32]王建华,王小林,颜志平.腹部介入放射学.上海:上海医科大学出版社.1998.113.
[33]王小林,董永华,龚高全.恶性梗阻性黄疸的双介入治疗.介入放射学杂志,1998,4,207.
[34]陈颐,王小林,王建华,等.胆道支架置放结合动脉化疗栓塞治疗恶性梗阻性黄疸.复旦学报(医学科学版),2001,28(6):516-518.
[35]甄彦利,马和平,张学军,等.恶性梗阻性黄疸的双介入治疗.内蒙古医学杂志,2006,38(3):211-212.
[36]王琼瑶,谢其根,杨章庚,等.)金属胆道支架置入联合介入化疗治疗恶性梗阻性黄疸的疗效.现代肿瘤医学,2006,14(5):587-588.
[37]丁田贵,尹立杰,高众等,胆道介入支架联合立体定向放射治疗恶性梗阻性黄疸.中华放射医学与防护杂志,2006(26):265-266.
[38]张骏,高宏,李力军.超声引导射频消融联合125I粒子置入治疗进展期胰腺癌.山东医药,2008,48(27):104-105.
[39]崔忠,杜冬,王振全,等.多极射频消融治疗不能切除胰腺癌的临床应用研究.华北国防医药,2008;20(5):7-9。
[40]张啸,张筱凤,杨建锋.经内镜射频消融和置人内支架联合治疗不能切除的胆胰肿瘤.中华消化内镜杂志.2006,23(4):252-255。
[41]范卫君,吴沛宏,张亮,等.Ⅲ、Ⅳ型肝门区胆管腺癌的介入治疗.中华放射学杂志,2005,39(9):925-929.
[42]吕民生,余昌中,宋丽霞.腔内放疗在恶性梗阻性黄疸治疗中的应用.中华现代外科学杂志,2007,4(6):416-417.
[43]Bruha R,Petrtyl J,Kubecova M,et al.Intraluminal brachytherapy and serf -expan dable stents in nonresectable biliary ma lign ancies- the question of long-term palliation.Hepatogastroenterology,2001,48(39):631-637.
[44]马军,常则灵,王秀兰,等.经导管192Ir近距离放射治疗局部晚期肝门部胆管癌[J].中国肿瘤临床,1998,26(8):568-569.
[45]谢大业,刘忠,胡国平,等.胰、胆、肝区癌组织间放射治疗[J].肝胆胰外科杂志,2002,14:142.
[46]文黎明,王洪州,黄春.记忆合金支架捆绑125-碘粒子在治疗食管癌狭窄中的临床应用,中华消化内镜杂志,2004;21(6):410-411.
[47]Joyce F,Burcharth F,Holm HH.Ultrasonically guided percutaneous implantation of iodine-125 seeds in pancreatic carcinoma.Int J Radiat Oncol BM Phys.1990,19:1049-1052.
[48]王雁飞,付逢吉,徐敏等.125I放射性粒子置入联合内引流术治疗恶性梗阻性黄疸20例疗效观察.山东医药,2007;47(20):15。
[49]张惠洁,宋志春,郭卫东.125I粒子种置治疗胆总管癌1例.包头医学院学报,2004;20(3):233.
[50]李启东,姚力,贾振庚.125I放射粒子治疗中晚期胰腺癌23例临床分析中国煤炭工业医学杂志,2005;8(6):561-562.
[51]李文靖,韩伟,陈军.放射性125I粒子置入联合健择顺铂动脉灌注治疗晚期胰腺癌.广西医学,2004;26(10):1455-1456.
[52]杜学明,许建辉,郎建华,等.多学科技术联合125I治疗癌梗阻性黄疸.介入放射学杂志,2008,17(5):346-348.
[53]丛辉,刘惠萍,王耀明.放射性粒子置入治疗恶性梗阻性黄疸.中华腹部疾病杂志,2006,6(10):721-722.
[54]罗开元,李波.125I粒子组织间放射治疗恶性肿瘤的临床应用.中华医学杂志,2001:81(12):754-755.
[55]靳大勇,倪晓凌,楼文辉.125I内放射粒子置入术治疗晚期胰头癌.外科理论与实践,2002;7(5):381-382.