体部伽马刀联合PTCD治疗恶性梗阻性黄疸的疗效观察

摘要

目的:探讨恶性梗阻性黄疸患者经皮肝穿刺胆管引流术(percutaneous transhepatic cholangial draiage,PTCD)联合体部伽马刀治疗的临床疗效.方法:回顾性分析广州军区武汉总医院2012年1月-2015年6月32例恶性梗阻性黄疸患者,所有患者均无手术指征或拒绝手术治疗,先在超声引导下行PTCD治疗,术后1周行病情评估,条件允许患者开始接受体部伽马刀治疗.利用CT定位,放疗计划用50％等剂量曲线包绕95％以上肿瘤体积,单次剂量3.0 ～4.0 Gy/次,治疗次数10～ 15次,治疗结束后,定期复查肝功能,磁共振或增强CT等检查以了解患者黄疸消退及肿瘤缓解情况,并通过随访观察其生存时间.结果:32例患者经治疗后黄疸消退明显,身体状况明显改善,总有效率为75.0％,1年生存率达65.6％,平均生存时间较单纯行胆道引流治疗有所提高.结论:PTCD联合体部伽马刀治疗恶性梗阻性黄疸,有安全、有效、适应范围广的优点,尤其对于高龄、身体状况差、失去手术治疗的恶性肿瘤患者,能够有效的改善生活质量,延长生存时间,不失为一种好的治疗手段.%Objective:To discuss the clinical observation on treatment of malignant obstructive jaundice applied body gamma knife combined with PTCD.Methods:Retrospectively analyse 32 cases of patients with malignant obstructive jaundice in Wuhan General Hospital of Guangzhou Military Command from January 2012 to June 2015.All patients had no surgical indications or refused surgical treatment.PTCD treatment under ultrasound guidance was completed,assessment of the disease after 1 week of operation.Eligible patients began to accept body gamma knife treatment.Using CT location,the radiotherapy planning was the 50％ isodose curve wrapping around more than 95％ of the tumor volume, the single dose was 3.0 ～ 4.0 Gy/times, treatment times was 10 ～ 15.Regular review of liver function,MRI and enhanced-CT were used to understand jaundice regression status and tumor remission after treatment,observed the survival time of the patients by follow-up.Results:32 cases of jaundice dissipated significantly after treatment.Physical condition improved significantly,total efficiency was 75.0％ and the 1 year survival rate was 65.6％.The average survival time was increased comparing with the treatment of biliary drainage.Conclusion:The treatment of malignant obstructive jaundice applied body gamma knife combined with PTCD is safe, effective and wide adaptation.It is a good treatment and can effectively improve the survival time and quality of life especially for the cancer patients of elder,poor physical condition and not surgical treatment.