Huang X H, Wu S H, Li P, Ke Q, Weng X T, Li L, Liu D X, Zhuang S W, Sun J H, Guo W H
Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025,China.
Department of Interventional Radiology, Zhangzhou Municipal Hospital, Zhangzhou 350025, China.
Zhonghua Gan Zang Bing Za Zhi. 2022 Jul 20;30(7):702-709. doi: 10.3760/cma.j.cn501113-20220728-00399.
To investigate the efficacy, safety and prognostic factors of percutaneous biliary stent combined with iodine-125 seed chain brachytherapy (radiotherapy) in the treatment of malignant obstructive jaundice. Data of 107 cases with malignant obstructive jaundice treated with percutaneous biliary stent implantation from January 2017 to December 2020 were retrospectively analyzed. Among them, 58 cases received biliary stent combined with iodne-125 seed chain brachytherapy (study group), and 49 cases received biliary stent implantation (control group). The changes of bilirubin, stent patency time, complications, overall survival (OS) and prognostic factors were analyzed in both groups. The incidence of complications in the study group and the control group were 17.2% and 18.3% respectively, and the difference was not statistically significant (=0.974). Serum total bilirubin levels were decreased significantly in both groups at one month after surgery (<0.001). Postoperative stent patency time was significantly better in the study group (10.0±1.6 months) (95% : 8.2～12.5) than that in the control group (5.2±0.4 months) (95% : 4.1～6.0, <0.001). The median OS was longer in the study group (11.2±1.8 months) (95% : 9.2～12.8) than that in the control group (8.0±1.1 months) (95% : 8.0～12.8, <0.001). Multivariate analysis result showed that stent combined with brachytherapy (=0.08, 95% :0.04～0.15, <0.001) and receiving further anti-tumor therapy after surgery (=0.27, 95% :0.15~0.49, <0.001) were independent risk factors affecting the patency of biliary stents. Preoperative percutaneous transhepatic biliary drainage (=0.46, 95%:0.28～0.74, =0.002), stent combined with brachytherapy (=0.23, 95%:0.14～0.39, <0.001) and receiving further anti-tumor therapy after surgery (=0.37, 95%:0.22～0.61, <0.001) were independent risk factors affecting OS. Percutaneous biliary stent combined with brachytherapy is safe and effective in the treatment of malignant obstructive jaundice, which can significantly prolong the patency time of biliary stent and the survival time of patients.
探讨经皮胆道支架联合碘-125粒子链近距离放射治疗（放疗）在恶性梗阻性黄疸治疗中的疗效、安全性及预后因素。回顾性分析2017年1月至2020年12月期间接受经皮胆道支架植入术治疗的107例恶性梗阻性黄疸患者的数据。其中，58例接受胆道支架联合碘-125粒子链近距离放射治疗（研究组），49例接受胆道支架植入术（对照组）。分析两组患者胆红素变化、支架通畅时间、并发症、总生存期（OS）及预后因素。研究组和对照组并发症发生率分别为17.2%和18.3%，差异无统计学意义（=0.974）。两组术后1个月血清总胆红素水平均显著下降（<0.001）。研究组术后支架通畅时间显著优于对照组（10.0±1.6个月）（95%：8.2～12.5）（对照组为5.2±0.4个月）（95%：4.1～6.0，<0.001）。研究组中位OS长于对照组（11.2±1.8个月）（95%：9.2～12.8）（对照组为8.0±1.1个月）（95%：8.0～12.8，<0.001）。多因素分析结果显示，支架联合近距离放射治疗（=0.08，95%：0.04～0.15，<0.001）及术后接受进一步抗肿瘤治疗（=0.27，95%：0.15~0.49，<0.001）是影响胆道支架通畅的独立危险因素。术前经皮肝穿刺胆道引流（=0.46，95%：0.28～0.74，=0.002）、支架联合近距离放射治疗（=0.23，95%：0.14～0.39，<0.001）及术后接受进一步抗肿瘤治疗（=0.37，95%：0.22～0.61，<0.001）是影响OS的独立危险因素。经皮胆道支架联合近距离放射治疗治疗恶性梗阻性黄疸安全有效，可显著延长胆道支架通畅时间及患者生存时间。
