摘要
目的：初步研究经皮胆道支架联合125 I粒子腔内植入治疗恶性梗阻性黄疸的临床效果。方法选择失去根治性手术机会或不愿行手术治疗的恶性梗阻性黄疸患者32例，施行经皮胆道支架联合125 I粒子植入术，初步分析其临床效果。患者术前行生化常规、血常规、肿瘤标志物、凝血功能、肝胆胰脾彩色超声、CT及MR胆胰管成像（ MRCP）等检查，明确患者一般情况、肿瘤大小、范围及梗阻部位。先在B超引导下行经皮经肝胆管引流（ PTCD），1周后在DSA下施行经皮胆道支架植入。根据术中造影显示支架的即刻扩张情况，选择同时或分期行125 I粒子植入术。粒子植入后1周、1个月、3个月行生化常规检查及DSA下胆管造影，采用重复测量的方差分析方法比较术前与术后肝功能指标水平变化情况；同时观察125 I粒子有无移位、脱落及支架通.情况。术后3个月经CT测量肿瘤体积。肿瘤体积术前与术后变化情况采用配对t检验。结果32例患者经治疗后一般身体状况明显改善，黄疸消退明显。术后1周，血清总胆红素水平（TBIL）由术前（302±169）μmol/L降至（108±50）μmol/L，血清直接胆红素水平（DBIL）由术前（250±160）μmol/L降至（85±43）μmol/L，差异有统计学意义（F 值分别为76.32、58.23，P 值均＜0.01）。术后3个月，肿瘤最大径由术前（3.78±1.14）cm降为（3.14±1.28）cm，肿瘤最小径由（2.80±0.88）cm降为（1.93±1.00）cm，差异均有统计学意义（t值分别为5.11、6.73，P值均＜0.05）。 Kaplan-Meier生存曲线分析得出术后平均生存时间（9.9±0.7）个月。结论经皮胆道支架联合125 I粒子植入术在延长患者生存时间、支架通.时间及改善患者生存质量方面近期疗效确切，具有安全、简便、创伤小、无绝对禁忌证及可反复应用等优点。
Objective To evaluate the clinical application of the treatment on malignant obstructive jaundice by combination of percutaneous biliary stent placement and 125 I particles intraluminal implanation.Methods As a prospective study , 32 patients with malignant obstructive jaundice who either have no opportunity for radical operations or unwilling to be surgically treated were enrolled to be treated with percutaneous biliary stent placement and 125 I particles intraluminal implanation.Biochemical routine tests , blood routine tests , tumor markers , coagulation function , color ultrasound , CT and magnetic resonance cholangiopancreatography were conducted prior to the operation to obtain general information of the clinical status of the patients and the tumor and the site of obstruction.Percutaneous transhepatic cholangial drainage was performed first under the B -type ultrasound system.After one week , biliary stents were placed under DSA.According to the stent expansion presented by real-time DSA imaging , 125 I particles were implanted simultaneously or afterwards.Routine biochemical tests and cholangiopancreatography under DSA were conducted in one week , one month and three months after the implantation.Variance analysis was performed with repeated measurements to compare the difference of liver function indexes pre -and post-operation.Meanwhile, 125I particle displacement, falling off and stent patency were observed.After three months, the tumor size was measured by CT.Student t-test was used to compare the tumor sizes of pre-and post-operation.Results The symptoms of jaundice resolved and the general physical conditions improved in 32 patients substantially.The total bilirubin level decreased from preoperative level of （302 ±169）μmol/l to the level of （108 ±50）μmol/l at one week following the surgery , and the indirect bilirubin level decreased from preoperative level of （ 250 ±160 ）μmol/l to the level of （ 85 ±43 ）μmol/l at one week following the surgery（F=76.32,58.23,P〈0.01）.The maximal diameters of the tumors decreased from preoperative size of （3.78 ±1.14）cm to the size of （3.14 ±1.28）cm at three months following the surgery, and the minimal diameters of the tumors decreased from preoperative size of （ 2.80 ±0.88 ） cm to the size of （ 1.93 ± 1.00）cm at three months following the surgery, and the differences were statistically significant （t=5.11, 6.73,P〈0.05）.By using Kaplan-Meier survival curve, the average survival periods were （ 9.9 ± 0.7） months.Conclusions Percutaneous biliary stent placement and 125 I particles intraluminal implanation have definite short-term effects in prolonging survival time , stent patency time and improving the living standard of the patients.The technique is safe and simple.It only needs small incision , has no absolute contraindications and can be applied repeatedly .
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2014年第5期403-407,共5页
Chinese Journal of Radiology
关键词
黄疸
梗阻性
支架
放射学
介入性
Jaundice,obstructive
Stents
Radiology,interventional
