【摘要】 目的分析比较经皮肝穿刺植入普通金属裸支架与放射性125I粒子支架治疗恶性胆道梗阻的临床疗效差异。方法选择2015年5月至2016年9月期间于中南大学湘雅二医院放射介入科进行治疗的32例恶性胆道梗阻患者,随机选择其中11例患者作为观察组,行经皮肝穿刺胆道引流及放射性125I粒子支架植入;21例为对照组,行经皮肝穿刺胆道引流及普通胆道金属裸支架植入,对比分析两组术前和术后1个月总胆红素(TIBL)、直接胆红素(DBIL)、癌胚抗原(CEA)、糖类抗原(CA19-9)指标变化以及支架通畅时间、生存时间的差异。结果两组患者均成功植入胆道普通金属裸支架或125I放射性粒子支架,术后造影胆道通畅,手术成功率100%。术后1个月两组TIBL、DBIL均显著降低,差异无统计学意义(P>0.05),术后1个月CEA、CA19-9观察组均低于对照组,差异有统计学意义(P<0.05)。术后观察组支架中位通畅时间及平均通畅时间(5.83个月,7.55个月)均长于对照组(2.23个月,2.53个月),差异有统计学意义(P<0.05),观察组3、6、9、12个月生存率分别为90.9%、90.9%、72.7%、54.5%,对照组分别为80.9%、33.3%、23.8%、9.5%,观察组支架通畅时间及生存时间显著高于对照组,差异有统计学意义(P均<0.05)。结论放射性125I粒子支架是治疗恶性胆道梗阻安全、有效的微创治疗方法,既可迅速解除胆道梗阻又可有效抑制肿瘤生长,与普通胆道金属裸支架相比,能明显提高支架通畅时间和延长患者生存期,是标本兼治的姑息性治疗方案,值得临床推广应用。更多还原

【Abstract】 Objective To compare the curative effect between percutaneous transhepatic cholangial drainage（PTCD） plus bare metal stent implantation and PTCD plus radioactive¹²⁵I seed stent implantation in treating malignant biliary obstruction. Methods A total of 32 patients with malignant biliary obstruction,who were treated at Interventional Radiology Department of the Second Xiangya Hospital of Central South University, China, during the period from May 2015 to September 2016, were enrolled in this study. The patients were randomly divided into the study group（n =11） and the control group（n =21）. PTCD plus radioactive¹²⁵I seed stent implantation was employed in the patients of the study group, and PTCD plus bare metal stent implantation was adopted in the patients of the control group. Total bilirubin（TIBL）, direct bilirubin（DBIL）, carcinoembryonic antigen（CEA）, and carbohydrate antigen（CA19-9） were tested before and one month after the treatment, the stent patency time and the survival time were calculated. The results were compared between the two groups. Results Successful stent implantation was accomplished in all patients of both groups. Biliary radiography showed that the biliary ducts were patent, the operation success rate was 100%. One month after the treatment, the TIBL and DBIL levels were significantly decreased, but the differences in the reduction of TIBL and DBIL levels between the two groups were not statistically significant（P>0.05）. One month after the treatment, the levels of CEA and CA19-9 in the study group were lower than those in the control group, the differences between the two groups were statistically significant（P<0.05）. The median stent patency time and the mean stent patency time in the study group were 5.83 months and 7.55 months respectively, both of which were longer than those in the control group（2.23 months and2.53 months respectively）, the differences between the two groups were statistically significant（P<0.05）. The3-, 6-, 9-and 12-month survival rates in the study group were 90.9%, 90.9%, 72.7% and 54.5%respectively, which were significantly higher than 80.9%, 33.3%, 23.8% and 9.5%, respectively, in the control group（P <0.05）. Conclusion For malignant biliary obstruction, implantation of radioactive¹²⁵I seed stent is a safe, effective and minimally-invasive treatment. It can not only quickly relieve bile duct obstruction but also effectively inhibit tumor growth. Compared with conventional bare metal stent implantation, radioactive¹²⁵I seed stent implantation can remarkably improve the stent patency time and prolong patient’s survival time. It is a palliative, both temporary and permanent, treatment. Therefore, it is worthy of clinical application.更多还原