Radioactive 125I seed implantation for pancreatic cancer with unexpected liver metastasis: A preliminary experience with 26 patients

BACKGROUNDPreoperative diagnosis rate of pancreatic cancer has increased year by year. The prognosis of pancreatic cancer patients with unexpected liver metastasis found by intraoperative exploration is very poor, and there is no effective and unified treatment strategy.AIMTo evaluate the therapeutic effect of radioactive ¹²⁵I seed implantation for pancreatic cancer patients with unexpected liver metastasis.METHODSThe demographics and perioperative outcomes of patients who underwent ¹²⁵I seed implantation to treat pancreatic cancer with unexpected liver metastasis between January 1, 2017 and June 1, 2019 were retrospectively analyzed. During the operation, ¹²⁵I seeds were implanted into the pancreatic tumor under the guidance of intraoperative ultrasound, with a spacing of 1.5 cm and a row spacing of 1.5 cm. For patients with obstructive jaundice and digestive tract obstruction, choledochojejunostomy and gastroenterostomy were performed simultaneously. After operation, the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel treatment.RESULTSPreoperative imaging evaluation of all patients in this study showed that the tumor was resectable without liver metastasis. There were 26 patients in this study, including 18 males and 8 females, aged 60.5 ± 9.7 years. The most common tumor site was the pancreatic head (17, 65.4%), followed by the pancreatic neck and body (6, 23.2%) and pancreatic tail (3, 11.4%). Fourteen patients (53.8%) underwent palliative surgery and postoperative pain relief occurred in 22 patients (84.6%). The estimated blood loss in operation was 148.3 ± 282.1 mL and one patient received blood transfusion. The postoperative hospital stay was 7.6 ± 2.8 d. One patient had biliary fistula, one had pancreatic fistula, and all recovered after conservative treatment. After operation, 7 patients received chemotherapy and 19 did not. The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not (68.6% vs 15.8%, P = 0.012). The mean overall survival of patients in the chemotherapy group and non-chemotherapy group was 16.3 mo and 10 mo, respectively (χ² = 7.083, P = 0.008).CONCLUSIONRadioactive ¹²⁵I seed implantation combined with postoperative chemotherapy can prolong the survival time and relieve pain of pancreatic cancer patients with unexpected liver metastasis.     

动脉化疗栓塞治疗恶性梗阻性黄疸

目的：探讨胆道支架置放后动脉化疗栓塞治疗恶性梗阻性黄疸(MOJ)的并发症和疗效，研究影响黄疸复发时间和患者生存期的预后因素。方法：51例MOJ患者放置胆道支架后接受动脉化疗栓塞术(TACE)，观察手术并发症，血清胆红素下降程度，随访黄疸复发时间和患者生存期。分析性别，年龄，肿瘤类型，术前血清胆红素浓度、碱性磷酸酶、谷丙转氨酶、白蛋白、血红蛋白浓度，梗阻时间，梗阻水平10个因素对黄疸复发时间和患者生存期的影响。结果：51例共计放置支架64枚，行TACE术86次，技术成功率为100％。1例于术后1个月死亡，在治疗过程中，4例出现肝脓肿。4例失访，51例生存期为1～34个月，平均9．0个月，中位值8．0个月。22例黄疸复发，复发率43．2％，黄疸复发时间2～14个月，平均11．0个月，中位值9．0个月。单因素(P=0．010)和多因素(P=0．010)分析均显示术前血清总胆红素浓度是影响患者生存期的重要因素。单因素分析显示对黄疸复发有显著影响的因素为肿瘤类型(P=0．035)。结论：MOJ患者放置胆道支架后进行TACE术，可以延缓黄疸复发，延长患者生存期。术前血清总胆红素浓度高的患者生存期较短；肝细胞肝癌患者的黄疸复发时间较非肝细胞肿瘤患者明显延长，黄疸复发率亦低于后者。     

门静脉支架同步125I粒子条植入序贯经导管动脉化疗栓塞术治疗肝癌伴门静脉癌栓

目的观察门静脉支架同步¹²⁵I粒子条植入序贯经导管动脉化疗栓塞术(TACE)治疗肝细胞癌(HCC)伴门静脉癌栓的临床价值。方法对15例HCC伴门静脉癌栓患者行门静脉支架同步¹²⁵I粒子条植入序贯TACE治疗,并随访至死亡;观察技术成功率、并发症,分析生存时间、支架通畅时间、累积生存率及支架通畅率。结果15例手术均成功,术中未见严重并发症。术后中位生存期为8.5个月;1、3、6、9、12、15、18和20个月累积生存率分别为100%、86.67%、73.33%、46.67%、26.67%、13.33%、6.67%和0;中位支架通畅中位时间8.5个月,1、3、6、9、12、15和18个月支架累积通畅率为100%、86.67%、80.00%、80.00%、53.33%、46.67%和40.00%。结论门静脉支架同步¹²⁵I粒子条植入序贯TACE治疗HCC伴门静脉癌栓安全、可行,并可延长支架通畅时间和生存期。     

胆道内支架置入术治疗恶性梗阻性黄疸的疗效分析

目的 探讨经皮肝胆道内支架置入治疗恶性梗阻性黄疸的疗效及并发症。方法 对32例恶性梗阻性黄疸患者经皮肝穿胆道内行支架置入术,其中28例为内涵管,4例为金属内支架。随访35－376天,观察近中期疗效和并发症。结果 经皮肝胆道内支架置入术技术成功率为100％,置入术后1周血总胆红素水平较置入前明显下降（P＜0.001)。开通时间平均为101天,半年开通率为56.25%,并发症发生率24.98%,为主要包括胰腺炎和逆行胆道感染等。结论 经皮肝胆管内架置入术疗效可靠,是一种安全,可作为恶性胆管阻塞介入治疗的一种姑息性疗法。     

恶性梗阻性黄疸76例介入治疗疗效分析

目的：探讨介入方式治疗恶性梗阻性黄疸（malignant obstructive jaundice,MOJ）的临床效果及价值。方法对76例MOJ患者行经皮肝穿刺胆管内支架置入术（percutaneous transhepatic insertion of biliary stent,PTIBS）,术后35例患者联合介入方法抗肿瘤综合治疗。结果76例MOJ患者均成功置入金属胆道支架,共置入金属胆道支架102枚。根据患者不同的梗阻类型置入支架放置部位不同,30例肝门部置入金属胆道支架共56枚（26例置入双支架）,34例胆总管部置入支架共34枚,12例壶腹部置入支架12枚。术后2周复查血清总胆红素（TBIL）、直接胆红素（DBIL）及谷丙转氨酶（ALT）,进行独立样本t检验,P值均〈0.05。随访74例患者（失访2例）,PTIBS术后是否行介入抗肿瘤治疗患者的生存时间及支架的通畅时间进行卡方检验,P值均〈0.05。结论 PTIBS技术成功率高,退黄效果明显。PTIBS结合介入方式进行抗肿瘤治疗,可延长患者的生存时间及支架的通畅时间。     

自膨胀式支架在梗阻性黄疸治疗中的应用

目的　评价自膨胀式支架在梗阻性黄疸姑息性治疗中的价值。方法　我们对 18例梗阻性黄疸患者 ,实施了经皮肝穿 ,胆道内自膨胀式支架植入术。对其中 17例患者进行了 2～ 44周随访。结果　 18例内支架均成功植入 ,除 1例外 ,术后 2周内血清胆红素及碱性磷酸酶都显著降低 ,胆道梗阻引起的症状缓解。 3例 (17% )发生支架堵塞 ,平均支架通畅时间 18周。结论　自膨胀式内支架植入 ,是姑息性治疗梗阻性黄疸的安全有效手段。     

Retrospective analysis of T-lymphocyte subsets and cytokines in malignant obstructive jaundice before and after external and internal biliary drainage

ObjectiveTo study changes in T lymphocyte subsets, cytokines, and liver enzymes in patients with malignant obstructive jaundice (MOJ) before and after external biliary drainage (percutaneous transhepatic cholangiography drainage, PTCD) and internal biliary drainage (percutaneous transhepatic insertion of biliary stents, PTIBS).MethodsMOJ patients undergoing PTCD (n = 44) and PTIBS (n = 38) at our hospital were enrolled in the study from January 2017 until December 2019. Peripheral blood total bilirubin (TBIL), direct bilirubin (DBIL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio, interleukin (IL)-2, IL-6, and tumor necrosis factor (TNF)-α were measured before and 1 week after biliary drainage.ResultsThere was no significant difference in any parameter between the two groups before biliary drainage. TBIL, DBIL, AST and ALT following PTCD were significantly lower than before PTCD. By contrast, CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio, IL-2, IL-6 and TNF-α showed no significant difference before and 1 week after PTCD. TBIL, DBIL, AST, ALT, IL-6 and TNF-α were significantly lower following PTIBS than before PTIBS. CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio and IL-2 were significantly higher following PTIBS than before PTIBS.ConclusionBoth PTCD and PTIBS were effective for treatment of MOJ, but PTIBS was more beneficial for recovery of immune function.     

Unilateral versus bilateral stent insertion for malignant hilar biliary obstruction

Purpose

To determine the clinical efficiency and long-term outcomes between unilateral and bilateral stent insertion in patients with malignant hilar biliary obstruction.

Methods

From August 2012 to February 2016, 63 consecutive patients with malignant hilar biliary obstruction were treated with unilateral or bilateral stent insertion at our center. The bilateral stents were inserted using the side-by-side technique. The clinical efficiency and long-term outcomes were compared between the two groups.

Results

Unilateral and bilateral stent insertions were successfully performed in 31 of 33 and 27 of 30 patients, respectively (P = 0.912). No procedure-related complication occurred. Clinical success was achieved in 29 of 31 patients in the unilateral stent group and in 26 of 27 patients in the bilateral stent group (P = 0.637). During the follow-up, re-obstruction of stent occurred in five patients in the unilateral stent group and in three patients in the bilateral stent group (P = 0.58). The significant differences were not observed in the stent patency time (368 vs. 387 days, P = 0.685) and survival (200 vs. 198 days, P = 0.751) between two groups. Based on the univariate and multivariate analyses, the independent risk factors for decreasing the survival time included higher Eastern Cooperative Oncology Group performance status (P = 0.018), higher alanine aminotransferase level (P = 0.009), and absence of anticancer treatment after stent insertion (P = 0.002).

Conclusion

Compared to bilateral stent insertion for malignant hilar biliary obstruction, unilateral stent insertion can provide comparable clinical efficiency and long-term outcomes.

     

经内镜胆道支架置放治疗胆道恶性梗阻性疾病

目的 :探讨经内镜胆道支架置放治疗胆道恶性梗阻性疾病。方法 :有 2 4例胆道恶性梗阻病人接受治疗 ,其中 11例被放置金属支架 ,13例被放置塑料支架。结果 :插管成功率 89% ,并发症 2例 ,急性胰腺炎和急性胆管炎各 1例 ,并发症发生率 7.4 %。血清胆红素由 2 89umol/L下降到术后 1周的 10 4umol/L。3个月、6个月存活率分别达 95 %及 78%。结论 :经内镜胆道支架置放治疗胆道恶性梗阻性疾病是安全、有效的方法     

18F-FDG PET/CT联合MR胰胆管造影多模态显像诊断良恶性梗阻性黄疸

目的 探讨¹⁸F-FDG PET/CT联合MR胰胆管造影（MRCP）多模态显像对良恶性梗阻性黄疸的诊断价值。方法 回顾性分析57例梗阻性黄疸患者的PET/CT与MRCP资料,根据最终诊断分为恶性梗阻组（n=31）和良性梗阻组（n=26）,分析¹⁸F-FDG PET/CT与MRCP特征及多模态联合显像的诊断效能。结果 恶性梗阻组中,胰胆管中重度扩张13例（13/31,41.94%）,良性梗阻组中,胰胆管中重度扩张1例（1/26,3.85%）,差异有统计学意义（P=0.047）。恶性梗阻组病灶最大标准摄取值（SUV_max）为10.54±6.69,高于良性组（3.78±1.68;P<0.001）。¹⁸F-FDG PET/CT和MRCP诊断恶性梗阻性黄疸的灵敏度为90.32%（28/31）和61.29%（19/31）,差异有统计学意义（P=0.046）;特异度为84.62%（22/26）和76.92%（20/26）,差异无统计学意义（P=0.725）;准确率为87.72%（50/57）和68.42%（39/57）,差异有统计学意义（P=0.013）。¹⁸F-FDG PET/CT联合MRCP多模态显像诊断恶性梗阻性黄疸的灵敏度、特异度和准确率分别为96.77%（30/31）、88.46%（23/26）和92.98%（53/57）,与¹⁸F-FDG PET/CT比较差异均无统计学意义（P均>0.05）,与MRCP比较,灵敏度、准确率差异有统计学意义（P=0.002、0.002）,特异度差异无统计学意义（P=0.463）。¹⁸F-FDG PET/CT联合MRCP、¹⁸F-FDG PET/CT、MRCP诊断良恶性梗阻性黄疸与最终诊断结果的一致性Kappa值分别为0.858、0.752及0.375。结论 ¹⁸F-FDG PET/CT联合MRCP多模态显像有利于提高梗阻性黄疸的诊断准确率,对诊断与临床治疗决策具有重要指导意义。     

A prospective, randomized multicenter trial comparing DoubleLayer and polyethylene stents for malignant distal common bile duct strictures

BACKGROUND AND STUDY AIMS: Endoscopic biliary stenting is an established treatment for malignant obstructive jaundice. Stent clogging continues to be a major problem with plastic stents. The aim of this study was to carry out a prospective comparison of two stents with different materials and shapes: the Olympus DoubleLayer stent (DLS; perfluoro alkoxy, without sideholes) and the standard polyethylene (PE) stent (with sideholes). PATIENTS AND METHODS: A total of 120 patients (70 women; mean age 71, range 36 - 91) with jaundice due to malignant strictures of the middle to distal third of the common bile duct were randomly assigned to receive either DLS (n = 60) or PE (n = 60) biliary stents. Patients with cholangitis, hemobilia, previous biliary drainage, hilar stricture, or ampullary cancer were excluded. RESULTS: In all, 28 DLS patients (47 %) and 17 PE stent patients (29 %) died without clinical evidence of stent occlusion after a mean of 114 and 105 days, respectively ( P < 0.05). Twenty-six DLS patients (43 %) and 38 PE stent patients (63 %) had symptoms of stent clogging after a mean of 144 and 99 days, respectively ( P < 0.05). Stent dysfunction (stent orifice impacted on the bile duct or duodenal wall, stent migration) was recorded in six DLS patients (10 %) and five PE patients (8 %) (n. s.). Kaplan-Meier analysis of DLS and PE stent clogging-free survival showed a significantly longer patency period with the DLS stents (P = 0.0005). CONCLUSIONS: These results show that DoubleLayer stents have a longer patency period than PE stents. Patients who received PE stents had a higher risk of stent occlusion (relative risk 3.05; 95 % CI, 1.57 - 5.89) before death than DLS patients.     

EUS-guided choledochoduodenostomy for palliative biliary drainage in patients with malignant biliary obstruction: results of long-term follow-up

Five patients with obstructive jaundice caused by malignant periampullary biliary stenosis underwent EUS-guided choledochoduodenostomy (EUS-CDS) from the first portion of the duodenum using a convex echoendoscope and a needle knife. All the steps of the procedure including passage dilatation and the plastic stent placement were performed through the accessory channel of the echoendoscope over the guide wire. Stent insertion was technically successful in all five patients. The procedure was also clinically effective in relieving jaundice in all cases. One patient developed pneumoperitoneum, which resolved with conservative management. Stent exchange was successful in seven of eight attempts in patients with stent occlusion. One failure was due to tumor invasion to the choledochoduodenal fistula. Stent patency was maintained in the remaining patients throughout their survival period. The average stent patency was 211.8 days. EUS-CDS from the first portion of the duodenum appears to be feasible and safe in cases of obstructive jaundice caused by distal bile duct obstruction.     

Clinical stages of recurrent hepatocellular carcinoma: A retrospective cohort study

BACKGROUNDHepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide, and has relatively high recurrence rates. Few studies have been published on the clinical stages of recurrent HCC.AIMTo assess the applicability of the Barcelona Clinic Liver Cancer (BCLC) staging for recurrent HCC and the need to establish clinical stage criteria for recurrent HCC.METHODSThe clinicopathological data of 81 patients with recurrent HCC who were admitted to the Hospital of Guangxi Zhuang Autonomous Region from January 2013 to December 2017 were collected. The patients were divided into three groups according to the BCLC staging system as follows: (1) Group A with BCLC stage A, 51 patients; (2) Group B with BCLC stage B, 14 patients; and (3) Group C with BCLC stage C, 16 patients. The median time to tumor recurrence and the median overall survival were compared. RESULTSThe median time to tumor recurrence in groups A, B, and C was 16 ± 1.5 mo, 10 ± 2.8 mo, and 6 ± 0.5 mo, respectively, with a statistically significant difference among them (χ² = 70.144, P < 0.05); no statistically significant difference was noted between group A and group B (χ² = 2.659, P > 0.05), although there were statistically significant differences between group A and group C and between group B and group C (χ² = 62.110, and 19.972, P < 0.05). The median overall survival in groups A, B, and C were 42 ± 5.1 mo, 22 ± 3.1 mo, and 13 ± 1.8 mo, respectively, with a statistically significant difference among them (χ² = 38.949, P < 0.05); there were statistically significant differences between group A and group B, group A and group C, and group B and group C (χ² = 9.577, 37.172, and 7.183, respectively; P < 0.05).CONCLUSIONThere are different prognoses in recurrent HCC patients according to the BCLC staging. Therefore, BCLC staging is applicable to recurrent HCC and it is essential to formulate clinical stage criteria for recurrent HCC.     

非血管性内支架置入术的临床应用(附19例分析)

目的：总结胆总管金属内支架置入术和食管带膜支架置入术与动脉化疗相结合治疗恶性胆道狭窄、食管恶性狭窄、食管气管瘘及食管纵隔瘘的临床经验和疗效分析。材料与方法：恶性梗阻性黄疸8例，恶性食管狭窄7例，恶性食管肿瘤并食管气管瘘或食管纵隔瘘4例，全部操作均在电视透视监视下进行。8例采用经皮肝穿胆道置入内支架均获成功，其中6例为一次性拦入支架，2例先行胆汁引流术（PTCD）后再置入金属内支架。支架植入后总胆红素均有不同程度的下降，2例支架置入后行动脉化疗。7例恶性食管狭窄，4例并食管气管瘘或食管纵隔瘘均一次性顺利完成内支架置放。8例内支架植入术后加动脉化疗平均生存期为8个月，支架植入后加动脉化疗组平均生存期为11个月。结论：胆道内支架植入术与动脉化疗相结合是治疗手术无能的胆道、食管恶性梗阻性狭窄的有效方法，且安全，简单。     

Percutaneous insertion of Zilver stent in malignant biliary obstruction

Background We evaluated the clinical efficacy and technical feasibility of the percutaneously inserted self-expandable nitinol stent (Zilver stent) for palliation of malignant biliary obstruction. Methods Seventeen patients with malignant tumors involving the intra- or extrahepatic bile duct who presented with obstructive jaundice underwent percutaneous insertion of a self-expandable nitinol stent. We retrospectively reviewed the hospital records of patients and evaluated the technical feasibility on stent placement, complications, patient survival, and duration of stent patency. Results Percutaneous biliary stenting with 27 Zilver stents was performed in 17 patients with malignant biliary obstruction. Technical success was 95%. Malposition of the stent was encountered in one patient. Minor technical problems were encountered in two patients: the introducer tip was broken during stent insertion, so endoscopic removal was done. Mean follow-up period for the 17 patients was 182 days (range 29–485 days): nine patients died of progressive disease at a mean follow-up of 151 days (range 61–371days) after stent insertion and eight patients remained alive at the final follow-up of 216 days (range 29–485 days). The median survival period for all patients was 277 days. The stent occlusion rate was 26% and the mean patency period was 280 days. In five patients, seven stents were obstructed by tumor ingrowth and overgrowth. Stent patency rates were 100%, 100%, 75%, 61%, and 41% at 1, 2, 3, 6, and 12 months, respectively. A late complication, erosive bleeding of the hepatic artery by the stent, developed in one patient. Conclusion Percutaneous biliary stenting using the nitinol stent is technically feasible and safe and clinically efficacious treatment for malignant biliary obstruction, even with a minor technical problem during stent insertion.     

A Meta-Analysis of Randomized Trials: Immediate Stent Placement vs. Surgical Bypass in the Palliative Management of Malignant Biliary Obstruction

ContextMany patients with unresectable pancreatic and peripancreatic cancer require treatment for malignant biliary obstruction.ObjectivesTo conduct a meta-analysis of the English language literature (1985–2011) comparing immediate biliary stent placement and immediate surgical biliary bypass in patients with unresectable pancreatic and peripancreatic cancer and analyze associated hospital utilization patterns.MethodsAfter identifying five randomized controlled trials comparing immediate biliary stent placement and immediate surgical biliary bypass, we performed a meta-analysis for dichotomous outcomes, using a random effects model. We compared resource utilization in terms of the number of hospital days before death by reviewing high-quality literature.ResultsThree hundred seventy-nine patients were identified. We found no statistically significant differences in success rates between the two treatments (risk ratio [RR] 0.99; 95% CI 0.93–1.05; P = 0.67). Major complications and mortality were not significantly higher after surgical bypass (RR 1.54; 95% CI 0.87–2.71; P = 0.14). Recurrent biliary obstruction was significantly less frequent after surgical bypass than after stent placement (RR 0.14; 95% CI 0.03–0.63; P < 0.01). Despite similar overall survival rates, longer survival was associated with more hospital days before death in stent patients than in surgical patients.ConclusionNearly all patients with unresectable pancreatic cancer benefit from some procedure to manage biliary obstruction. Patients with low surgical risk benefit more from surgery because the risk of recurrence and subsequent hospital utilization are lower than after stent placement.     

应用自膨式金属支架姑息治疗无法手术的恶性梗阻性黄疸

目的 评价自膨式金属支架植入成形术治疗无法手术的恶性梗阻性黄疸及临床疗效.方法 对105例无法手术治疗的恶性梗阻性黄疸患者行胆道内支架成形术,术后随访3～755天,观察患者的临床症状改善情况及支架通畅情况.结果 共植入支架129枚,初次治疗的技术成功率为94.3%,78%患者术后达到临床显效的标准.术后30天患者死亡率为7.6%(8/105),死因均与介入操作无关.术后患者的中位生存期为189天,支架中位通畅时间为246天.术后3、6个月的支架通畅率分别为92.1%和64.5%.结论 自膨式金属支架植入术是姑息治疗恶性梗阻性黄疸的有效方法,准确判断无法从胆道支架成形术中获益患者将有助于改善支架成形术后的远期疗效.     

金属支架姑息性治疗160例恶性梗阻性黄疸的临床观察

目的 探讨胆道金属支架(EMBS)植入术治疗恶性梗阻性黄疸的临床价值.方法 160例行EMBS植入术的恶性梗阻性黄疸患者为支架组,以30例同样失去手术机会但因经济条件所限经皮经肝穿刺胆道引流(PTCD)外引流治疗者为PTCD组.回顾性研究其支架通畅率、胆红素下降情况及并发症的发生情况.随访间期为3个月,Kaplan-Meier(1og-rank test)生存期分析比较支架组与PTCD组术后生存期差异.结果 2组患者厌食、皮肤瘙痒、尿色深染等症状较前均有不同程度改善;支架组总胆红素水平和直接胆红素水平治疗前[(218.78±2.29)、(128.82±2.40)μmoL/L]、治疗后7 d[(134.90±2.34)、(81.28 ±2.34)μmoL/L]、14 d[(83.18±2.40)、(51.29±2.45)μmol/L]、21 d[(40.74±2.29)、(25.70±2.40)μmol/L]比较均有不同程度的下降(P均=0.000),PTCD组总胆红素水平和直接胆红素水平治疗前[(223.57±2.58)、(127.60±2.59)μmoL/L]、治疗后7 d[(145.68±2.57)、(79.78±2.70)μmoL/L]、14 d[(87.57 ±2.58)、(58.36±2.46)μmol/L]、21d[(38.65±2.20)μmol/L,(29.46±2.20)μmoL/L]比较均有不同程度的下降(P均=0.000);但2组同期胆红素值的比较差异均无统计学意义(P均>0.05).支架组34例术后发生并发症,发生率为20.62%,有9例发生两种或两种以上并发症.PTCD组18例患者出现并发症,发生率为60.00%.支架组失访14例,136例患者死亡,支架组中位生存时间214 d;PTCD组无失访,30例患者均死亡,中位生存时间为75.5 d,生存期分析表明支架组生存时间较PTCD组长(P=0.000).结论 EMBS植入术治疗恶性梗阻性黄疸效果显著,相比PTCD外引流,支架内引流并发症少、恢复快,提高患者生存质量、延长生存期,是恶性梗阻性黄疸的一种理想的姑息性治疗方法.     

恶性梗阻性黄疸治疗探讨:胆道支架置入+碘-125粒子腔内照射联合治疗

目的研究胆道腔内碘-125粒子放射治疗恶性梗阻性黄疸的可行性并初步探讨其治疗方法。方法12例恶性梗阻性黄疸患者放置胆道支架后接受胆道碘125粒子腔内放射治疗。结果除3例患者于术后2~3个月因肿瘤晚期呼吸循环衰竭死亡外,其余病例均未出现黄疸,未见明显并发症。结论初步观察表明胆道支架置入 胆道碘125粒子腔内放射是治疗恶性梗阻性黄疸的一种安全可行的方法。     

多途径置金属支架治疗晚期恶性梗阻性黄疸162例

目的探讨应用多途径置金属支架治疗晚期恶性梗阻性黄疸的效果,为临床上选择更适当的方法治疗晚期恶性梗阻性黄疸提供依据。方法回顾分析162例晚期恶性梗阻性黄疸患者经内镜逆行胰胆管造影（ERCP）途径（n=129）、经皮经肝胆管引流（PTCD）途径（n=25）、联合ERCP和PTCD途径（n=8）置入金属支架治疗的情况。通过比较患者术前与术后1周肝功能指标,总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）的变化,评价3种方法的有效性。结果术后1周复查血清生化指标,TBIL、DBIL、IBIL、ALT、AST均显著下降（P〈0.01）。并发症发生主要是感染、出血、胰腺炎,经治疗后缓解,没有操作相关的死亡发生。3种方法均显著降低了肝功能指标,术后并发症在ERCP与PTCD组之间差异无统计学意义（P〉0.05）。ERCP＋PTCD因例数少,未见有并发症。结论多途径置金属支架治疗晚期恶性梗阻性黄疸的疗效确切,应该根据患者的具体情况选用合适的途径解除患者的黄疸、改善肝功能,提高生存质量。