Department of Interventional Radiology, Jining No.1 People's Hospital, Jining, China.
J BUON. 2020 Mar-Apr;25(2):1056-1062.
To explore the efficacy and safety of percutaneous transhepatic cholangial drainage (PTCD)-based biliary stent placement combined with iodine-125 (125I) particle intracavitary irradiation versus palliative internal biliary-intestinal drainage in the treatment of pancreatic head cancer-induced obstructive jaundice.
The clinical data of 110 patients with pancreatic head cancer, who were admitted to and treated in our hospital from July 2013 to July 2016 were registered. Among them, 55 patients underwent PTCD-based biliary metallic stent placement combined with 125I particle intracavitary irradiation (125I group), while the other 55 patients received palliative internal biliary-intestinal drainage (Surgery group). The jaundice index, and liver function parameters before and after treatment, duration of stent patency, tumor growth and incidence of adverse reactions were compared between the two groups of patients, and the patient overall survival (OS) time was followed up and recorded.
The two therapies both effectively alleviated jaundice and improved liver function in patients. There were no statistically significant differences in the preoperative liver function parameters albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and direct bilirubin (DBIL) between the two groups of patients, and the liver function was significantly improved at each period of time after operation, showing a statistically significant difference. At 3 months after operation, 125I group had substantially lower levels of ALT, AST, TBIL and DBIL, but a prominently higher level of ALB than Surgery group. The complications of patients mainly included pancreatitis, recurrent biliary infections and stent blockage, which were resolved after symptomatic treatments. After operation, the maximum diameter of tumors was enlarged in both groups, and the tumor size in Surgery group and 125I group was increased from 3 months after operation to 6 months after operation, with a more obvious increase in Surgery group. The total clinical benefit rate (CBR) was 61.8% (34) and 54.5% (30), and the mean survival time of patients was 13.4±4.9 months and 12.7±4.6 months in 125I group and Surgery group, respectively. Moreover, the OS in 125I group was notably superior to that in Surgery group.
PTCD-based biliary metallic stent placement combined with 125I particle intracavitary irradiation can effectively relieve jaundice, improve liver function, repress tumor growth, prolong survival and produce tolerable adverse reactions in the patients with pancreatic head cancer who lose the opportunity for surgery or are intolerant to surgery.
探讨经皮经肝胆道引流（PTCD）联合胆道支架置入碘-125（125I）粒子腔内放疗与姑息性内胆管-肠内引流治疗胰头癌所致梗阻性黄疸的疗效和安全性。
回顾性分析 2013 年 7 月至 2016 年 7 月我院收治的 110 例胰头癌患者的临床资料。其中 55 例行 PTCD 联合胆道金属支架置入联合 125I 粒子腔内放疗（125I 组），55 例行姑息性内胆管-肠内引流（手术组）。比较两组患者治疗前后黄疸指数、肝功能指标、支架通畅时间、肿瘤生长及不良反应发生率，随访并记录患者总生存（OS）时间。
两种治疗方法均能有效缓解患者黄疸，改善肝功能。两组患者术前肝功能白蛋白（ALB）、丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）、总胆红素（TBIL）、直接胆红素（DBIL）比较差异无统计学意义，术后各时间点肝功能均明显改善，差异有统计学意义。术后 3 个月时，125I 组 ALT、AST、TBIL、DBIL 明显低于手术组，ALB 明显高于手术组。患者并发症主要包括胰腺炎、复发性胆道感染和支架阻塞，经对症治疗后缓解。术后两组患者肿瘤最大直径均增大，手术组和 125I 组肿瘤大小从术后 3 个月增加到术后 6 个月，手术组增大更为明显。125I 组总临床受益率（CBR）为 61.8%（34 例），手术组为 54.5%（30 例），125I 组和手术组患者的平均生存时间分别为 13.4±4.9 个月和 12.7±4.6 个月，125I 组 OS 明显优于手术组。
PTCD 联合胆道金属支架置入联合 125I 粒子腔内放疗可有效缓解黄疸，改善肝功能，抑制肿瘤生长，延长生存时间，不良反应可耐受，对于失去手术机会或不耐受手术的胰头癌患者具有重要意义。
