Kuvshinoff B W, Armstrong J G, Fong Y, Schupak K, Getradjman G, Heffernan N, Blumgart L H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Br J Surg. 1995 Nov;82(11):1522-5. doi: 10.1002/bjs.1800821122.
Twelve patients with irresectable or recurrent hilar cholangiocarcinoma were treated with internal biliary drainage followed by intraluminal (iridium-192) and external-beam radiotherapy. Biliary drainage was accomplished by means of a combined surgical and interventional radiological approach. Initial biliary decompression was performed surgically by tumour resection, intrahepatic biliary enteric bypass or distal biliary-enteric anastomosis with a temporary stent. Maintenance of internal biliary drainage and application of intraluminal radiotherapy were accomplished radiologically with the use of percutaneous dilatation and metallic expandable biliary endoprostheses. Median survival was 14.5 months; all 12 patients survived for at least 6 months. Early complications during radiotherapy were minor and included two patients with cholangitis and one with transient haemobilia. Jaundice was relieved in ten of 12 patients, while episodes of cholangitis were seen during long-term follow-up in 11 (median 1.5 episodes per patient). Internal biliary drainage, in conjunction with radiotherapy, appears to be safe and effective palliation of irresectable or recurrent hilar cholangiocarcinoma. Patients can maintain a reasonable quality of life with an acceptable incidence of cholangitis, without the hindrance of external drainage devices.
12例无法切除或复发的肝门部胆管癌患者接受了内胆管引流，随后进行腔内（铱-192）和外照射放疗。胆管引流通过外科手术和介入放射学联合方法完成。初始胆管减压通过肿瘤切除、肝内胆管肠吻合术或带有临时支架的远端胆管肠吻合术进行手术操作。通过经皮扩张和金属可扩张胆管内支架，以放射学方法实现内胆管引流的维持和腔内放疗的应用。中位生存期为14.5个月；所有12例患者均存活至少6个月。放疗期间的早期并发症较轻微，包括2例胆管炎患者和1例短暂性胆道出血患者。12例患者中有10例黄疸得到缓解，而在长期随访期间，11例患者出现胆管炎发作（中位每名患者1.5次发作）。内胆管引流联合放疗似乎是无法切除或复发的肝门部胆管癌安全有效的姑息治疗方法。患者能够维持合理的生活质量，胆管炎发生率可接受，且不受外引流装置的妨碍。
