摘要
目的比较^(125)I粒子单/双链联合胆管支架治疗恶性梗阻性黄疸的临床疗效。方法回顾性分析2018年9月至2021年12月在郑州大学第一附属医院介入科接受^(125)I粒子链联合胆管支架植入治疗的67例恶性梗阻性黄疸患者的临床资料,男44例,女23例,年龄39~80(62.0±9.7)岁。根据治疗方式分为2组:36例接受^(125)I粒子单链联合胆管支架治疗为单链组,31例接受^(125)I双链联合胆管支架治疗为双链组。分析2组的技术成功率、临床成功率、并发症、术后8周生化和肿瘤指标[(总胆红素(TB)、直接胆红素(DB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、糖类抗原19-9(CA19-9))]、支架通畅时间、中位无进展生存时间(mPFS)和中位总生存时间(mOS)的差异。结果单链组和双链组技术成功率(100%比100%)、临床成功率(97.2%比96.8%)、主要并发症发生率(5.6%比6.5%)差异均无统计学意义(均P>0.05)。两组术前与术后8周的TB、DB、ALT、AST和CA19-9指标差异均有统计学意义(均P<0.05),但两组间术前与术后8周指标的差值比较差异均无统计学意义(均P>0.05)。双链组支架通畅时间和mPFS比单链组长[8.6个月(95%CI:6.9~10.4个月)比6.2个月(95%CI:5.8~6.6个月),3.2个月(95%CI:3.0~3.4个月)比3.0个月(95%CI:2.9~3.1个月),均P<0.05]。单链组和双链组mOS分别为11.2个月(95%CI:8.3~14.1个月)和13.4个月(95%CI:9.9~16.9个月),差异无统计学意义(P=0.137)。结论^(125)I粒子双链较单链可延长胆管支架通畅时间和mPFS,远期生存指标仍需进一步观察。
Objective To compare the clinical efficacy of single/double ^(125)I-seed strands combined with biliary stents in the treatment of malignant obstructive jaundice.Methods Totally 67 cases of patients with malignant obstructive jaundice who received single/double^(125)I-seed strands combined with biliary stents implantation from September 2018 to December 2021 were analyzed retrospectively.Among them,36 patients received single ^(125)I-seed strands combined with biliary stents(single strand group)and 31 patients received double ^(125)I-seed strands combined with biliary stents(double strands group).The technical success rate,clinical success rate,complications,biochemical and tumor indexes at 8 weeks after operation[total bilirubin(TB),direct bilirubin(DB),alanine transaminase(ALT),aspartate transaminase(AST),carbohydrate antigen 19-9(CA19-9)],stent patency time(SP),median progression-free survival time(mPFS)and median survival time(mOS)were analyzed.Results There was no significant difference(P>0.05)in technical success rate(100%vs 100%),clinical success rate(97.2%vs 96.8%)and major complications(5.6%vs 6.5%)between single strand group and double strands group.There were significant differences in TB,DB,ALT,AST and CA19-9 indicators between the two groups before and 8 weeks after operation(all P<0.05),but there was no significant difference in the difference value of preoperative and postoperative 8-week indicators between the two groups(all P>0.05).The SP and mPFS of double-stranded stents were longer than those of single-stranded stents.[8.6 months(95%CI:6.9-10.4)vs 6.2 months(95%CI:5.8-6.6),3.2 months(95%CI:3.0-3.4)vs 3.0 months(95%CI:2.9-3.1),all P<0.05].The mOS of single and double strands groups was 11.2 months(95%CI:8.3-14.1)and 13.4 months(95%CI:9.9-16.9)respectively,with no statistical difference(P=0.137).Conclusion Compared with single ^(125)I-seed strands,double ^(125)I-seed strands can prolong biliary SP and mPFS,but the long-term survival index still needs further observation.
作者
宋梦瑶
张程智
孙占国
刘一铭
许凯豪
韩新巍
焦德超
Song Mengyao;Zhang Chengzhi;Sun Zhanguo;Liu Yiming;Xu Kaihao;Han Xinwei;Jiao Dechao(Department of Interventional Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第33期2607-2613,共7页
National Medical Journal of China
