单纯胆道支架与125I粒子支架腔内照射治疗恶性梗阻性黄疸

摘要

目的 探讨单纯胆道支架与支架联合125I粒子条植入腔内照射治疗恶性梗阻性黄疸的临床价值.方法 对62例恶性阻塞性黄疸患者行经皮经肝胆管引流(PTCD)后随机分组:A组31例行胆道支架联合125I粒子条植入(实验组),B组31例行单纯胆道支架植入(对照组).比较两组患者术前、术后黄疸消退、复发情况、T淋巴细胞亚群变化以及生存时间.结果 A、B两组患者PTCD术前及支架植入术后1周血清总胆红素测定差异无统计学意义(P＞0.05).术后1个月、3个月血清总胆红素测定,A组优于B组(P＜0.05).随访期内,A组再次发生胆道梗阻1例,B组12例(P＜0.05).对比PTCD术前,A组术后1～2周CD4及CD4/CD8比值明显升高(P＜0.05),CD3变化无差异(P＞0.05).B组术后1～2周CD3、CD4及CD4/CD8比值变化无明显差异(P＞0.05).A组患者中位生存时间10.9个月,B组患者中位生存时间7.1个月,两组差异有统计学意义(P＜0.05).结论 125I粒子条联合胆道支架植入腔内照射治疗恶性梗阻性黄疸在黄疸消退、改善机体免疫机能及延长患者生存时间等方面均优于单纯胆道支架植入治疗.%Objective To compare biliary stent versus combined biliary stent with intracavitary irradiation using 125I seed implantation to treat patients with malignant obstructive jaundice.Methods 62 patients with malignant obstructive jaundice after drainage with PTCD were randomized into two groups:Group A:biliary stent combined with 125I seed implantation (the treatment group),Group B:biliary stent alone (the control group).Postoperative change in jaundice,tumor recurrence,T lymphocyte subsets and survival time were compared between these two groups.Results The change in total serum bilirubin in the two groups of patients showed no significant difference at postoperative 1 month (P ＞ 0.05).However,Group A was better than Group B (P ＜ 0.05) at postoperative I month and 3 months.On follow-up,one patient developed recurrent biliary obstruction in Group A and 12 patients in Group B (P ＜ 0.05).When compared with the preoperative values,CD4 and the ratio of CD4/CD8 increased significantly in Group A at 1 to 2weeks postoperative (P ＜ 0.05),and there was no difference in CD3 (P ＞ 0.05).For patients in Group B,there were no significant difference in CD3,CD4 and CD4/CD8 ratio at 1 ～ 2 weeks postoperative when compared with the preoperative values (P ＞ 0.05).The median survival time for Group A was 10.9 months and for Group B 7.1 months (P ＜ 0.05).Conclusions Intracavitary irradiation using 125I seed implantation combined with biliary stent was better than stenting alone in the treatment of malignant obstructive jaundice.The combined treatment better relieved jaundice,improved immune function and prolonged survival time.