胆道支架置入+～（125）I腔内治疗中医黄疸的初步评价
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摘要
背景 胆道支架置入术已逐渐成为恶性梗阻性黄疸患者的主要姑息治疗手段之一,然而通过临床实践观察,在胆道支架置入后3-6个月部分患者开始出现支架内再狭窄,从而影响支架置入的远期治疗效果,人们曾尝试在胆道支架置入后行胆道腔内放射治疗,然而由于以往的放射治疗受到方法及放射源的限制,照射时间短,且患者需体外携带引流管等,方法较为复杂,取得的疗效不明显。新近国内生产的放射性碘-125粒子,具有低剂量率,可持续照射等特点,可作为永久性植入放射源,弥补了以往放射源的不足,将碘-125粒子应用于胆道内照射治疗,有望改善胆道支架置入后再狭窄情况,而国内外暂无相关报道。
目的 通过对胆道腔内行碘125粒子内照射,初步评价胆道支架成形+胆道腔内放射性碘-125粒子内照射治疗中医不同证型黄疸的疗效,试图改善胆道支架放置后再狭窄或闭塞。
方法 2003年9月至2006年2月住院病人26例,其中2例患者未完成随访给予筛除,其余24例患者,男性13例,女性11例;年龄40～91岁,平均69.5岁。全组病例均有明显黄疸,血清总胆红素平均321.7μmol/L,直接胆红素平均204.5μmol/L。将24例恶性梗阻性黄疸患者按中医辩证分为阴黄组及阳黄组,各组患者分为治疗组(胆道支架+胆道腔内粒子植入组)及对照组(单纯胆道支架置入组),所有患者随访3个月,术后第1、2、3月复查总胆红素,直接胆红素及支架、粒子位置。通过对胆道腔内行碘125粒子内照射,评价碘125腔内放疗对恶性梗阻性黄疸胆道支架置入术后再狭窄或闭塞的治疗效果。同时通过中医辩证分型,评价胆道支架植入联合胆道腔内放射治疗中医各型黄疸的治疗效果。
结果 26例患者均成功置入胆道支架,治疗组10例患者植入碘-125放射粒子,平均随访3个月,其中2例单纯支架置入患者术后1月内因肿瘤晚期合并呼吸循环衰竭死亡,给予筛除。2例患者于胆道粒子置入后2月余因肿瘤晚期呼吸循环衰竭而无黄疸死亡,另有2例患者于粒子置入术后2月因术口愈合不良拔除粒子,通过对患者总胆红素、直接胆红素、血象、肝肾功能及支架通畅情况的复查,阳黄粒子植入组与阴黄粒子植入组、阳黄粒子植入组与阳黄单纯支架置入组、阴黄粒子植入组与阴黄单纯支架置入组、粒子植入组与单纯支架置入组术后一月、二月、三月总胆红素、直接胆红素的数据统计分析,各组比较均无显著性差异,但通过对患者术后3月胆红素水平的分析,其中阳黄粒子植入患者术后3月的治疗效果好于阴黄粒子植入患者。粒子植入的术后3月支架通畅率为100%,高于单纯支架置入患者。胆道粒子植入对患者血象、肝肾功能无明显影响。
结论 初步结果表明胆道支架置入+胆道碘125粒子腔内放射是治疗黄疸的一种安全
Background 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. People have ever tried to use biliary tract intracavitary therapy after the biliary stent implantation, but the curative effects were not obvious because of the limit of the radiotherapy methods and radiation source, such as short exposure time and carrying the drainage tube. 1-125 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 hope to decrease the restenosis of the stent by applying the 1-125 seeds in the bile duct. There were no reports about it. Purpose To evaluate the effect to the different syndromes of jaundice by biliary stent implantation -fintraluminal brachytherapy by 1-125 seeds. Try to settle the problem of restenosis and obstruction.Method The patients in hospital 9th , 2003-2nd, 2006. Male thirteen and female eleven, the average is 69.5 year-old(40-91year-old).All of them have the obvious jaundice, which the totle bilirubin is 321. 7μmol/L and the direct bilirubin is 204. 5μmol/L. We put the 24 cases into two groups yin-yellow and yang-yellow by differentiation, which are put into treatment group (biliary stent implantation + intraluminal brachytherapy by 1-125 seeds) and antitheses group (biliary stent implantation). All the patients will be followed 3 months and check-up the totle bilirubin, the direct bilirubin, the position of the stent and the seeds. We hope to evaluate the effect to the restenosis and obstruction of the stent in the malignant obstructive jaundice patients by 1-125 seeds. And to valuate the effect of the different syndrome of the jaundice by biliary stent implantation +intraluminal brachytherapy.
by 1-125 seeds.Result The 26 cases were implanted into biliary stent, ten of which were implanted into 1-125 seeds. In the 3-month follow-up, two of them were implanted biliary stent died from failure of the respiratory and circulation system in the advanced stage of tumor, who were screen out. Two of them were implanted biliary stent+ 1-125 seeds died from failure of the respiratory and circulation system in the advanced stage of tumor without jaundice. In the stent+ 1-125 seeds group, two patients were ending theropy and the 1-125 seeds were pulled out because of the bad concrescent. According to the data of the totle bilirubin, the direct bilirubin, the white blood cell, the function of liver and kidney and the condition of the stent, there were no obviously difference. But it shows that that the curative effect of the yang-yellow stent+ 1-125 seeds group was better than the yin-yellow stent+ 1-125 seeds group by analyzsing the level of the bilirubin. And we found the stent opening rate of the 1-125 seeds group after 3 months was 100%, which was higher than the stent group. Intraluminal brachytherapy by 1-125 seeds have no obviously effect to the white blood cell and the function of liver and kidney of the patients.Conclusion The preliminary observation indicated that biliary stent implantation +intraluminal brachytherapy by 1-125 seeds in treating the malignant obstructive jaundice is a safe and effective method. More over it is a little better in treating the yang-yellow syndrome than yin-yellow syndrome.
目的 通过对胆道腔内行碘125粒子内照射,初步评价胆道支架成形+胆道腔内放射性碘-125粒子内照射治疗中医不同证型黄疸的疗效,试图改善胆道支架放置后再狭窄或闭塞。
方法 2003年9月至2006年2月住院病人26例,其中2例患者未完成随访给予筛除,其余24例患者,男性13例,女性11例;年龄40～91岁,平均69.5岁。全组病例均有明显黄疸,血清总胆红素平均321.7μmol/L,直接胆红素平均204.5μmol/L。将24例恶性梗阻性黄疸患者按中医辩证分为阴黄组及阳黄组,各组患者分为治疗组(胆道支架+胆道腔内粒子植入组)及对照组(单纯胆道支架置入组),所有患者随访3个月,术后第1、2、3月复查总胆红素,直接胆红素及支架、粒子位置。通过对胆道腔内行碘125粒子内照射,评价碘125腔内放疗对恶性梗阻性黄疸胆道支架置入术后再狭窄或闭塞的治疗效果。同时通过中医辩证分型,评价胆道支架植入联合胆道腔内放射治疗中医各型黄疸的治疗效果。
结果 26例患者均成功置入胆道支架,治疗组10例患者植入碘-125放射粒子,平均随访3个月,其中2例单纯支架置入患者术后1月内因肿瘤晚期合并呼吸循环衰竭死亡,给予筛除。2例患者于胆道粒子置入后2月余因肿瘤晚期呼吸循环衰竭而无黄疸死亡,另有2例患者于粒子置入术后2月因术口愈合不良拔除粒子,通过对患者总胆红素、直接胆红素、血象、肝肾功能及支架通畅情况的复查,阳黄粒子植入组与阴黄粒子植入组、阳黄粒子植入组与阳黄单纯支架置入组、阴黄粒子植入组与阴黄单纯支架置入组、粒子植入组与单纯支架置入组术后一月、二月、三月总胆红素、直接胆红素的数据统计分析,各组比较均无显著性差异,但通过对患者术后3月胆红素水平的分析,其中阳黄粒子植入患者术后3月的治疗效果好于阴黄粒子植入患者。粒子植入的术后3月支架通畅率为100%,高于单纯支架置入患者。胆道粒子植入对患者血象、肝肾功能无明显影响。
结论 初步结果表明胆道支架置入+胆道碘125粒子腔内放射是治疗黄疸的一种安全
Background 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. People have ever tried to use biliary tract intracavitary therapy after the biliary stent implantation, but the curative effects were not obvious because of the limit of the radiotherapy methods and radiation source, such as short exposure time and carrying the drainage tube. 1-125 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 hope to decrease the restenosis of the stent by applying the 1-125 seeds in the bile duct. There were no reports about it. Purpose To evaluate the effect to the different syndromes of jaundice by biliary stent implantation -fintraluminal brachytherapy by 1-125 seeds. Try to settle the problem of restenosis and obstruction.Method The patients in hospital 9th , 2003-2nd, 2006. Male thirteen and female eleven, the average is 69.5 year-old(40-91year-old).All of them have the obvious jaundice, which the totle bilirubin is 321. 7μmol/L and the direct bilirubin is 204. 5μmol/L. We put the 24 cases into two groups yin-yellow and yang-yellow by differentiation, which are put into treatment group (biliary stent implantation + intraluminal brachytherapy by 1-125 seeds) and antitheses group (biliary stent implantation). All the patients will be followed 3 months and check-up the totle bilirubin, the direct bilirubin, the position of the stent and the seeds. We hope to evaluate the effect to the restenosis and obstruction of the stent in the malignant obstructive jaundice patients by 1-125 seeds. And to valuate the effect of the different syndrome of the jaundice by biliary stent implantation +intraluminal brachytherapy.
by 1-125 seeds.Result The 26 cases were implanted into biliary stent, ten of which were implanted into 1-125 seeds. In the 3-month follow-up, two of them were implanted biliary stent died from failure of the respiratory and circulation system in the advanced stage of tumor, who were screen out. Two of them were implanted biliary stent+ 1-125 seeds died from failure of the respiratory and circulation system in the advanced stage of tumor without jaundice. In the stent+ 1-125 seeds group, two patients were ending theropy and the 1-125 seeds were pulled out because of the bad concrescent. According to the data of the totle bilirubin, the direct bilirubin, the white blood cell, the function of liver and kidney and the condition of the stent, there were no obviously difference. But it shows that that the curative effect of the yang-yellow stent+ 1-125 seeds group was better than the yin-yellow stent+ 1-125 seeds group by analyzsing the level of the bilirubin. And we found the stent opening rate of the 1-125 seeds group after 3 months was 100%, which was higher than the stent group. Intraluminal brachytherapy by 1-125 seeds have no obviously effect to the white blood cell and the function of liver and kidney of the patients.Conclusion The preliminary observation indicated that biliary stent implantation +intraluminal brachytherapy by 1-125 seeds in treating the malignant obstructive jaundice is a safe and effective method. More over it is a little better in treating the yang-yellow syndrome than yin-yellow syndrome.
引文
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[2] Soulez G, Gagner M , Therasse E, et al. Malignant biliary obstruction: preliminary result of palliative treatment with hepaticogastrostomy under fluroscopic, endoscopic, and laparoscopic guidance. Radiology, 1994;192: 2411.
[3] Irving J, Adam A, Dick R, et al. Gianturco expandable metallic biliary stents: results of a European clinical trial. Radiology, 1989;172: 321.
[4] Brountzos E, Petropoulos E, Kelekis N. et al. Malignant biliary obstruction: Management with percutaneous metallic stent placement. Hepato Gastroenterology, 1999;46: 2764.
[5] 李学彪,畅坚,岳茂兴,等.镍钛记忆合金胆道支架在胆道梗阻、狭窄时的临床应用.中国腹部疾病杂志,2001;1(1):46—47.
[6] 谢宗贵,张希全,李凡东.胆道支架技术5年回顾(213例随访报告)中华肝胆外科杂志,2002;8(10):595-597.
[7] 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.
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