胆道支架联合125I 粒子腔内治疗胆管癌恶性黄疸的疗效评价*

目的:探讨经皮金属胆道支架和支架联合125I 粒子腔内照射治疗对胆管癌引起的恶性梗阻性黄疸的临床疗效差异。方法:选择2012年10月至2014年10月无法根治手术的胆管癌引起的恶性梗阻性黄疸患者52例，先行支架置入，根据是否置入125I 粒子分为治疗组（26例）与对照组（26例）。 对比两组治疗前后生化常规、瘤体最大径、最小径、再出现黄疸时间、生存时间等是否存在统计学差异。结果:经治疗1 、3 、6 个月后两组肝功能较术前均明显改善，差异有统计学意义（P < 0.05）；比较两组术后1 个月胆红素降低值，差异无统计学意义（P < 0.05）；比较两组术后3 、6 个月与术前，术后3 个月与1 个月，术后6 个月与3 个月胆红素降低值，差异有统计学意义（P < 0.05）；经治疗后治疗组瘤体明显减小，对照组明显增大，差异有统计学意义（P < 0.05）。 治疗组平均生存时间为（12.83± 1.57）个月，24个月总生存率为38.46% ；对照组为（8.89± 1.0）个月，24个月总生存率为11.54% ，差异有统计学意义（P < 0.05）。 结论:经皮金属胆道支架联合125I 粒子腔内照射治疗较单纯支架置入治疗，在具有相同减黄效果同时，亦可有效抑制胆管肿瘤生长、延长患者生存期及支架通畅时间。同时内装施源式有利于更方便观察疗效、调整粒子位置、追加治疗剂量及放射材料的回收。 

Evaluation of the curative effect of biliary stents combined with 125I particles for intracavitary treatment of malignant jaundice in cholangiocarcinoma

Objective: To investigate differences in the clinical curative effects of percutaneous biliary metal stents and stents combined with 125I particles for intracavitary irradiation treatment of malignant jaundice in cholangiocarcinoma. Methods:A total of 52 patients with malignant obstructive jaundice caused by cholangiocarcinoma that was unsuitable for radical curative surgery were select-ed. All of the patients were subjected to simple stenting and subsequently divided into two groups: the control group ( 26cases) and the treatment group (26cases). The treatment group consisted of patients who received implantation of 125I particles. Routine biochemistry tests were performed, and maximum and minimum tumor diameters were measured and assessed before and after treatment to detect statistically significant differences. The jaundice and survival time of patients between the two groups were also noted and compared. Results:The liver function of patients in both groups improved significantly at1, 3, and 6 months compared with that before operation; differences observed were statistically significant ( P<0.05). No significant difference in postoperative bilirubin levels was observed be-tween patients in the two groups (P>0.05). Significant differences in bilirubin levels were observed between groups as follows: liver functions of patients are different in preoperative 3 and 6 months after treatment and preoperative; postoperative3 months and 1 month after treatment; and postoperative 6 months and 3 months after treatment in two groups,differences observed were statistically significant (P<0.05). Tumor size significantly decreased in the treatment group after therapy but significantly increased in the control group; differences observed were statistically significant ( P<0.05). Patients in the treatment group showed an average survival time of 12.83±1.57months and 24-month survival rate of 38.46%. In the control group, the average survival time was8.89± 1.0 months and the24-month survival rate was 11 .54% . Again, differences observed were statistically significant (P<0.05). Conclusion:Similar to simple stent implantation, intracavitary irradiation with percutaneous biliary metal stents combined with 125I particles reduced jaundice. The use?of stents with 125I particles effectively inhibited tumor growth, increased the stent latency time, and prolonged patient survival. Further -more, the inside source type is conducive to recycling more conveniently to observe the curative effect and adjust the particle position, additional therapeutic dose, and radioactive materials.