经皮肝穿胆管内金属支架置入联合伽玛刀立体定向放射治疗肝门部胆管癌

目的探讨经皮肝穿胆管内金属支架置入联合伽玛刀立体定向放射治疗肝门部胆管癌的疗效及安全性。方法 2005年10月—2007年1月对不愿意手术或不能手术治疗的21例肝门部胆管癌患者,给予经皮肝穿胆管内金属支架置入联合伽玛刀立体定向放射治疗。肿瘤边缘剂量4～8Gy/次,隔日1次,总剂量为40～60 Gy,10～20 d完成。结果患者行经皮肝穿胆管内支架置入术后,血总胆红素及直接胆红素水平均有显著下降。治疗后1~3月复查,1例出现再梗阻,其余血胆红素水平基本上接近正常。肿瘤病灶CR 2例,PR 14例,PD 1例,SD 3例,总有效率(CR+PR)为80%。胆道支架植入术中及术后,出现血压下降4例,放疗不良反应以消化道反应多见,均为I~II度。患者中位生存期为14.5月,1、2年生存率分别为47.6%、14.2%。结论经皮肝穿胆管内支架置入术联合伽玛刀立体定向放射治疗是肝门部胆管癌的一种有效方法,并发症及不良反应少。

Treatment of hilar cholangiocarcinoma with percutaneous transhepatic placement of metallic stent combined with gamma knife stereotactic radiotherapy

Objective To retrospectively analyze the efficacy and safety of percutaneous transhepatic placement of metallic stent combined with gamma knife stereotactic radiotherapy in the treatment of hilar cholangiocarcinoma.Methods Twenty-one patients,who were diagnosed with hilar cholangiocarcinoma between October 2005 and January 2007,and were unwilling or unsuitable for surgery,were retrospectively reviewed.They received percutaneous transhepatic placement of metallic stents combined with gamma knife stereotactic radiotherapy.Radiotherapy was delivered every other day,with 4-8 Gy per fraction and tumor marginal dose of 40-60 Gy over 10-20 days.Results Serum total bilirubin and direct bilirubin levels were significantly decreased in all the patients after percutaneous transhepatic placement of metallic stents.After 1-3 months' treatment,the serum bilirubin levels were almost within the normal range except one who developed the stent obstruction.Twenty patients were assessable for response,i.e.CR in 2,PR in 14,PD in 1 and SD in 3,with a total response rate of 80%.Blood pressure decrease occurred in 4 patients during or after percutaneous transhepatic placement of metallic stents.Gastrointestinal toxicity,mainly grade one or two,was the most common adverse reaction of radiotherapy.The median survival time was 14.5 months,and the 1-and 2-year survival rates were 47.6% and 14.2%,respectively.Conclusion Percutaneous transhepatic placement of metallic stent combined with gamma knife stereotactic radiotherapy is an effective treatment approach to hilar cholangiocarcinoma,with few complications and adverse reactions.