Simmons Dia T, Baron Todd H, Petersen Bret T, Gostout Christopher J, Haddock Michael G, Gores Gregory J, Yeakel Peter D, Topazian Mark D, Levy Michael J
Department of Medicine, Division of Gastroenterology & Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Am J Gastroenterol. 2006 Aug;101(8):1792-6. doi: 10.1111/j.1572-0241.2006.00700.x. Epub 2006 Jun 16.
Traditionally, biliary brachytherapy sources are placed percutaneously via transhepatic drains or endoscopically via nasobiliary tubes (NBT). Another ERCP is needed for stent replacement after NBT removal. The aim of this study was to determine the feasibility and safety of endoscopic transpapillary insertion of irradiation sources through 10-Fr stents.
Medical records of Mayo Clinic Rochester patients undergoing biliary brachytherapy for hilar cholangiocarcinoma (CCA) were reviewed. Patients were part of a treatment protocol with curative intent including external beam radiation therapy (4,500 cGy), radiation sensitization (5-FU), and low dose rate (LDR) brachytherapy (<3,000 cGy) followed by liver transplantation. The 10-Fr biliary stent placed across the malignant biliary stricture was directly cannulated using a radiopaque (192)Ir embedded ribbon within a 300-cm long, 5.1-Fr plastic sheath. After withdrawal of the endoscope, the external end of the brachytherapy catheter was rerouted transnasally and secured. Each patient was hospitalized in a shielded room up to 24 h after which the brachytherapy catheter was removed by hand.
Between 1999 and 2004, 32 patients underwent biliary brachytherapy via endoscopically placed 10-Fr plastic stents (mean age 50.6 yr, 69% PSC, bilateral brachytherapy catheters 28.1%). The technical complication observed was immediate brachytherapy catheter displacement (7 of 32, 22%) managed by prompt brachytherapy catheter repositioning.
LDR biliary brachytherapy administration via endoscopically placed biliary stents is technically feasible and appears reasonably safe in select patients with unresectable perihilar CCA. Unlike NBTs, stents can potentially be placed in bilateral ductal systems to accommodate dual brachytherapy catheters when indicated.
传统上，胆道近距离放射治疗源是通过经肝引流管经皮放置或通过鼻胆管（NBT）经内镜放置。拔除NBT后需要再次进行内镜逆行胰胆管造影（ERCP）来更换支架。本研究的目的是确定通过10F支架经内镜乳头插入放射源的可行性和安全性。
回顾了梅奥诊所罗切斯特分院接受肝门部胆管癌（CCA）胆道近距离放射治疗患者的病历。患者是一项具有治愈意图的治疗方案的一部分，包括外照射放疗（4500 cGy）、放射增敏（5-氟尿嘧啶）和低剂量率（LDR）近距离放射治疗（<3000 cGy），随后进行肝移植。使用一根300厘米长、5.1F塑料鞘管内嵌入不透射线的（192）铱带，直接对横跨恶性胆管狭窄放置的10F胆道支架进行插管。在内镜撤出后，将近距离放射治疗导管的外端经鼻重新布线并固定。每位患者在屏蔽病房住院长达24小时，之后手动拔除近距离放射治疗导管。
1999年至2004年间，32例患者通过内镜放置的10F塑料支架接受了胆道近距离放射治疗（平均年龄50.6岁，69%原发性硬化性胆管炎，双侧近距离放射治疗导管28.1%）。观察到的技术并发症是近距离放射治疗导管立即移位（32例中的7例，22%），通过及时重新定位近距离放射治疗导管进行处理。
对于无法切除的肝门周围CCA患者，经内镜放置胆道支架进行LDR胆道近距离放射治疗在技术上是可行的，且似乎相当安全。与NBT不同，在有指征时，支架可潜在地放置在双侧胆管系统中以容纳双根近距离放射治疗导管。
