目的 利用携带125I放射性粒子胆道内照射支架应用于老年患者胆管癌所致胆道梗阻,评估该临床方法的有效性及安全性.方法 选取12例年龄中位数为72岁(60～82岁)因胆管细胞癌引起胆道梗阻病例,采用经皮肝穿刺胆道的方法,分别穿刺胆道二级分支,于胆道梗阻处置入125I放射性粒子胆道支架,术后留置胆道引流管3～5d,经造影确认支架通畅后予以拔除引流管,封闭穿刺道.记录患者介入术前后肝功能及生存时间进行统计分析.结果 介入术后所有患者均经胆道造影证实胆道支架通畅,总胆红素较术前下降(P＜0.05),患者中位生存期为13.2个月(5.5 ～22.0个月).结论 125I放射性粒子胆道支架在胆道恶性梗阻临床治疗方面能有效的达到引流胆汁退黄和近距离照射胆道肿瘤作用,对老年患者有良好安全性和有效性.%Objective To evaluate the effect and the safety of the application of biliary stent with 125I seed for intracavitary irradiation in treating biliary obstruction caused by cholangiocarcinoma in elderly patients.Methods 12 elderly patients with biliary obstruction caused by cholangiocarcinoma were selected,aged from 60 to 82,the median age was 72;percutaneous transhepatic puncture was made through bile duct and the second grand branches and the biliary stent with 125I seed for intracavitary irradiation was implanted at the lesion of obstruction;the biliary drainage tube was detained for 3 to 5 days and after the patency of the stent was confirmed by cholangiography,the tube was removed and the puncturing tract was closed;the hepatic function of the patients before and after the intervention and the survival time were recorded and statistical analysis was made.Results The patency of the stent was confirmed by cholangiography in all the patients after the intervention and the levels of total bilirubin were much lower than those before intervention (P＜0.05);the median survival time was 13.2 months,from 5.5 months to 22.0 months.Conclusions The application of biliary stent with 125I seed in treating malignant biliary obstruction is effective in biliary drainage and provides a close internal irradiation to cholangiocarcinoma,and more,prolongs the survival time,it is especially safe and effective for elderly patients.
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