摘要
目的:分析胆道支架联合^(125)I粒子植入治疗恶性梗阻性黄疸临床效果。方法:将98例行经皮肝穿刺胆管引流术后要求行胆管支架植入术的恶性梗阻性黄疸患者分为联合组(n=53)和单纯组(n=45),联合组患者采取^(125)I粒子条联合胆道支架植入,单纯组患者仅接受胆管支架植入。所有患者随访4~28个月,记录两组患者经皮肝胆管引流术前及胆道支架植入术后7 d、30 d和90 d总胆红素变化;记录两组患者再次发生胆道梗阻情况;分别于经皮肝胆管引流术前、胆道支架植入术后7 d,检测患者外周血T淋巴细胞亚群变化;比较两组患者术后生存时间。结果:两组患者均顺利完成胆道支架植入,手术成功率100%,联合组患者支架植入术后30 d和90 d时血清总胆红素水平均显著低于单纯组,差异有统计学意义(P<0.05);术后7 d时,联合组患者CD4水平和CD4/CD8比值均较术前升高,而单纯组患者CD4水平和CD4/CD8比值均较术前降低,差异有统计学意义(P<0.05);与单纯组相比,联合组患者术后7 d时CD4水平和CD4/CD8比值均升高(P<0.05);联合组中2例(3.8%)再次发生胆道梗阻,显著低于单纯组(37.8%),差异有统计学意义(P<0.001);联合组中位生存时间10.6个月,显著长于单纯组(7.5个月),差异有统计学意义(P<0.05)。结论:^(125)I粒子支架腔内照射治疗恶性梗阻性黄疸可缓解胆道梗阻症状,有助于改善患者细胞免疫功能,减少胆道梗阻的再次发生,对提高患者生存质量、延长生存时间具有重要意义。
Objective： To investigate the clinical effectiveness analysis on biliary stent combined with ^125I seed implantation in the treatment of malignant obstructive jaundice. Methods： 98 malignant obstructive jaundice patients undergoing percutaneous transhepatic biliary drainage requirement of biliary stent were divided into combined group（n=53） and simple group（n=45）. Patients in combined group were taken biliary stent combined with ^125I seed implantation, while in simple group were only taken biliary stent. All patients were followed up for 4 to 28 months. The changes of total bilirubin were recorded before percutaneous bile duct drainage, 7 d, 30 d and 90 d after biliary stent implantation. The recurrences of biliary obstruction of the two groups were recorded. The changes of T lymphocyte subsets in peripheral blood were detected before percutaneous bile duct drainage and after biliary stent implantation 7 d. The survival times of the two groups were compared. Results： All patients were successfully completed biliary stent implantation, surgical success rate was 100%. The total bilirubin levels of patients in combined group 30 d and 90 d after stent implantation were significantly lower than the simple group, the differences were statistically significant （P〈0.05）. After surgery 7 d, the CD4 level and CD4/CD8 ratio in combined group were increased compared with before surgery, while in the simple group were declined, the differences were statistically significant （P〈0.05）. Compared with the simple group, the CD4 level and CD4/CD8 ratio in combined group after surgery 7d were significantly increased （P〈0.05）. 2 cases （3.8%） of patients were recurrence of biliary obstruction, which were lower than 17 cases （37.8%） in the simple group, the difference was statistically significant （P〈0.001）. The median survival time in combined group was 10.6 months, which was significantly longer than 7.5 months in the simple group, the difference was statistically significant （P〈0.05
出处
《中国现代普通外科进展》
CAS
2017年第2期100-104,共5页
Chinese Journal of Current Advances in General Surgery
关键词
恶性梗阻性黄疸
^125I粒子
胆道支架
腔内照射
Malignant obstructive jaundice
^125I seed
Biliary stent
Intracavitary irradiation
