Levitt M D, Laurence B H, Cameron F, Klemp P F
Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia.
Gut. 1988 Feb;29(2):149-52. doi: 10.1136/gut.29.2.149.
Twenty four patients with malignant bile duct obstruction were treated with intraluminal radiotherapy using iridium-192 wire inserted through an endoscopically placed nasobiliary catheter. Biliary drainage after treatment was maintained by an endoprosthesis. The median dose of intraluminal radiotherapy was 6000 cGy; two patients with cholangiocarcinoma were given a second course because of disease extension; four patients with pancreatic carcinoma received additional external irradiation (3000 cGy). There was one early death from a cerebrovascular accident (30 day mortality, 4.2%). Cholangitis (30%) was the major early complication and stent blockage (40%) the major late complication; there were no complications directly attributable to radiotherapy. The median survival for patients with pancreatic carcinoma was 250 days and for cholangiocarcinoma, 300 days. This method is technically feasible and may prove safer than the transhepatic technique. The ability of intraluminal irradiation to improve palliation or lengthen survival in patients with malignant bile duct obstruction remains uncertain. Assessment by a prospective, controlled trial is essential.
24例恶性胆管梗阻患者接受了腔内放射治疗，通过经内镜放置的鼻胆管导管插入铱-192丝。治疗后通过内置假体维持胆汁引流。腔内放射治疗的中位剂量为6000 cGy；2例胆管癌患者因疾病进展接受了第二疗程治疗；4例胰腺癌患者接受了额外的外照射（3000 cGy）。有1例患者因脑血管意外早期死亡（30天死亡率，4.2%）。胆管炎（30%）是主要的早期并发症，支架堵塞（40%）是主要的晚期并发症；没有直接归因于放射治疗的并发症。胰腺癌患者的中位生存期为250天，胆管癌患者为300天。该方法在技术上是可行的，可能比经肝技术更安全。腔内照射改善恶性胆管梗阻患者的姑息治疗或延长生存期的能力仍不确定。必须通过前瞻性对照试验进行评估。
