Objective To evaluate the curative effect of three-dimensional conformal radiotherapy (3D-CRT)combined with percutaneous transhepatic cholangiography and drainage (PTCD) and percutaneous transhepatic insertion of biliary stent (PTBS) for the treatment of malignant obstructive jaundice. Methods PTCD and PTBS were carried out in 48 patients with malignant obstructive jaundice, which was followed by 3D-CRT. The total dose was 40 - 60 Gy/4 - 6w with 2.0 Gy/fractionation, and five fractionations were performed every week. The short-term effect and the survival rate were assessed. Results Successful drainage was achieved in all the 48 cases. The preoperative serum bilirubin level was (221.85 ± 54.73) μmol/. At one, two and three weeks after the treatment, the serum bilirubin level became (129.68 ± 23.58) μmol/L, (88.29 ± 15.70) μmol/L and (48.58 ± 11.61) μmol/L, respectively. After 3D-CRT treatment, complete remission (CR) of the tumor was seen in 3 , partial remission (PR) of the tumor in 36 and stable disease in 9 cases. The general response rate was 81.3%, and the one-year and two-year survival rates were 77.1% and 37.5% respectively. The median survival time was 18.5 months. No treatment-related serious complications occurred. Conclusion For patients with malignant obstructive jaundice,3D-CRT combined with PTCD and PTBS is a safe and effective palliative treatment. It can markedly relieve patient's clinical symptoms, improve the living quality and prolong the survival time. (J Intervent Radiol, 2012, 21: 395-398)%目的 观察经皮肝胆管穿刺引流(PTCD)及胆管内支架置入术(PTBS)联合三维适形放疗(3D-CRT)治疗恶性梗阻性黄疸的疗效及应用价值.方法 对48例恶性梗阻性黄疸患者行经皮肝胆管穿刺置管引流及胆管内支架植入,术后予3D-CRT,常规分割,总剂量DT 40 ～ 60 Gy/4 ～ 6周,观察近期疗效及生存率.结果 48例均引流成功,术前血清总胆红素(221.85 ± 54.73) μmol/L,术后1、2及3周总胆红素分别下降为(129.68 ± 23.58)、(88.29 ± 15.70) 和(48.58 ± 11.61) μmol/L;经3D-CRT后肿瘤完全缓解3例,部分缓解36例,稳定9例,肿瘤总有效率81.3%;1、2年累积生存率分别是77.1%、37.5%;中位生存期18.5个月;无治疗相关的严重并发症.结论 PTBD + 支架植入联合3D-CRT治疗恶性梗阻性黄疸是一种安全、有效的姑息性治疗方法,可以改善恶性肿瘤伴黄疸患者的临床症状,提高生存质量并延长生存时间.
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