恶性梗阻性黄疸介入治疗联合灌注化疗疗效评估

目的探讨胆道介入减黄治疗联合以吉西他滨为基础药物的灌注化疗（栓塞）治疗恶性梗阻性黄疸的疗效。 方法选择60例经皮肝穿刺胆汁引流术和/或经皮肝穿刺胆道支架治疗成功减黄的患者（总胆红素<50 μmol/L）,对原发肿瘤行灌注化疗（栓塞）治疗。进行随访直至患者死亡。随访内容包括：患者一般健康情况、实验室检查、影像学检查、支架开通情况、患者生存期,随访资料填入患者病例报告表。并与单纯行介入减黄治疗患者比较生存期、生活质量及支架开通率。 结果60例患者行PTBD治疗27例,胆道支架治疗33例。大部分患者均行2～3次灌注化疗（栓塞）术。主要毒性反应包括：①骨髓抑制,②消化道反应,③皮疹,④肝功能受损,大部分为Ⅰ～Ⅱ度。平均生存期（311.03±170.23）天,1个月、3个月,6个月以及12个月生存率分别为100%、93.33%、78.33%和28.33%。化疗灌注组生存率明显优于单纯减黄治疗组（χ²=8.693,P=0.003）。胆道支架平均开通时间为（238.48±171.26）天,1个月、3个月,6个月以及12个月开通率分别为100%、90.91%、57.58%和9.09%。与单纯PTBS减黄治疗比较,二组间支架开通率无明显差异（χ²=0.975,P=0.324）。灌注化疗后患者KPS评分83.05±6.38,与治疗前（64.28±5.51）比较有明显差异（t=12.79,P<0.001）。 结论以吉西他滨为基础化疗药物的TACE（TAI）治疗毒副作用较轻,患者对治疗的耐受性和依从性好;能够明显延长MOJ患者的生存期,提高患者的生活质量;在延长胆道支架的开通时间方面未能发现明显作用。

Therapeutic evaluation in malignant obstructive jaundice with PTBD and PTBS combined with intraarterial chemoperfusion and chemoembolization.

ObjectiveTo explore the therapeutic effect in malignant obstructive jaundice with PTBD and PTBS combined with gemcitabine-base intraarterial chemoperfusion and chemoembolization. MethodsWe choosed 240 patients with malignant obstructive jaundice who had been successfully drained(TBIL<50umol/L), and performed intraarterial chemoperfusion and chemoembolization. Patients were back in the outpatient clinic for a follow-up visit at 1 month, 3 months, 6 months, 12 months, 18 months and 24 months thereafter. Contents included general health related questions, laboratory results, image examination, drainage catheter, patency of stent and treatment of stent obstruction. Records were entered into CRF for subsequent processing and analysis. Compare survival, quality of life and rate of stent patency with non-perfusing chemotherapy group. ResultsOf the 60 patients 27 were initially treated with PTBD and 33 with PTBS. Most of them received intraarterial chemoperfusion and chemoembolization for 2-3 times. Major toxicities included myelosuppress, digestive reaction, rash and lesion of hepatic function, and most of them belonged to 1 to 2 grade. The mean survival was (311.03±170.23) d. The rate of survival was 100%, 93.33%, 78.33% and 28.33% for 1 month, 3 months, 6 months and 12 months, respectively. The Kaplan-Meier analysis showed survival rate of chemoperfusion group was prior to non-chemoperfusion group (χ²=8.693, P=0.003). The mean stent patency time was (238.48±171.26) d. The rate of patency was 100%, 90.91%, 57.58 and 9.09% for 1 month, 3 months, 6 months and 12 months, respectively. Stent patency times between two groups were not different statistically by log-rank test (χ²=0.975, P=0.324). Karnofsky index was 83.05±6.38 after intraarterial chemoperfusion and chemoembolization, and was significantly higher than pretherapy (t=12.79, P<0.001). ConclusionsPatients received gemcitabine-base intraarterial chemoperfusion and chemoembolization had the low toxic effects and high rate of clinical benefit. It could significantly prolong stent patency time.