【摘要】 目的 探讨热超液化碘油抗癌药乳剂栓塞治疗恶性梗阻性黄疸(MOJ)的安全性和可行性。方法 45例MOJ患者胆道支架置放术或经皮穿肝胆道引流术(PTBD)后,血清胆红素未降至正常水平即接受动脉化疗和热超液化碘油抗癌药乳剂栓塞术。栓塞方案:丝裂霉素10 mg和超液化碘油混合成乳剂,然后体外加热至100℃进行栓塞。参照WHO抗癌药物毒性分级标准观察毒性反应,Child-Pugh分级观察肝脏损害。随访患者黄疸复发时间和生存期。结果 45例MOJ患者TACE术前血清总胆红素浓度为53.4～102.5μmol/L,中位值78.6μmol/L。热超液化碘油总量2～10 mL,白细胞计数下降:Ⅰ度34.1%,Ⅱ度28.3%,Ⅲ～Ⅳ度12.1%;恶心呕吐:Ⅲ～Ⅳ度87.6%。肝脏Child-Pugh分级:6例A级升至B级,1例由A级升至C级,3例由B级升至C级。全部患者未出现心脏毒性。45例患者的生存期为4～82个月,中位值为9.0个月,17例黄疸复发,复发率37.8%,黄疸复发时间4～20个月,中位值11个月。结论 MOJ患者行有效引流后,即使胆红素未降至正常水平,用热超液化碘油抗癌药物乳剂单纯介入化疗栓塞治疗原发病灶是安全和有效的。更多还原

【Abstract】 Objective To evaluate the safety and efficiency of hot hyper liquefied lipiodol combined with low-dose chemotherapeutic drugs by using hyper-selection embolization in treatment of malignant obstructive jaundice(MOJ).Methods forty-five patients with MOJ, whose serum total bilirubin(TB) had not dropped to normal level after stent placement or percutaneous transhepatic biliary drainage,received arterial chemotherapy and hot hyper liquefied lipiodol combined with low-dose chemotherapeutic drugs by using hyper-selection embolization.During embolization,liquefied lipiodol emulsion containing MMC at dose of 10 mg was used.The toxicity and hepatic injury was observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion,respectively.The time of jaundice recurrence and survival were also observed during follow-up.Results Median total serum bilirubin in 45 patients was 78.6 μmol/L(range:53.4-102.5 μmol/L) before transhepatic arterial chemoembolization(TACE).The dose of MMC was 10mg and the amount of lipiodol was 2-10 ml.The white blood cell count decreased:grade Ⅰ in 34.1 %,grade Ⅱ in28.3% and grade Ⅲ-Ⅳ in 12.1%.Nausea and vomiting developed in 87.6% in grade Ⅲ-Ⅳ of the patients.According to ChildPugh,the hepatic injury became aggravated in 6 cases from A to B class,in one from A to C class,and in 3 from B to C class.No cardiac toxicity was observed in this series.The median survival time was 9.0 months with a range of 4 to 82 months.Jaundice recurred in 17 patients(37.8%) with a medium jaundice recurrence time of 11 months(range:4-20 months).Conclusion Hot hyper liquefied lipiodol combined with low-dose chemotherapeutic drugs by using hyper-selection embolization is safe and efficient in the management of patients with malignant obstructive jaundice with total serum bilirubin between 49 and 102 mol/L after biliary drainage.更多还原