CAJ | 학술논문

目的：初步研究经皮胆道支架联合125 I粒子腔内植入治疗恶性梗阻性黄疸的临床效果。方法选择失去根治性手术机会或不愿行手术治疗的恶性梗阻性黄疸患者32例，施行经皮胆道支架联合125 I粒子植入术，初步分析其临床效果。患者术前行生化常规、血常规、肿瘤标志物、凝血功能、肝胆胰脾彩色超声、CT及MR胆胰管成像（ MRCP）等检查，明确患者一般情况、肿瘤大小、范围及梗阻部位。先在B超引导下行经皮经肝胆管引流（ PTCD），1周后在DSA下施行经皮胆道支架植入。根据术中造影显示支架的即刻扩张情况，选择同时或分期行125 I粒子植入术。粒子植入后1周、1个月、3个月行生化常规检查及DSA下胆管造影，采用重复测量的方差分析方法比较术前与术后肝功能指标水平变化情况；同时观察125 I粒子有无移位、脱落及支架通.情况。术后3个月经CT测量肿瘤体积。肿瘤体积术前与术后变化情况采用配对t检验。结果32例患者经治疗后一般身体状况明显改善，黄疸消退明显。术后1周，血清总胆红素水平（TBIL）由术前（302±169）μmol/L降至（108±50）μmol/L，血清直接胆红素水平（DBIL）由术前（250±160）μmol/L降至（85±43）μmol/L，差异有统计学意义（F 值分别为76.32、58.23，P 值均＜0.01）。术后3个月，肿瘤最大径由术前（3.78±1.14）cm降为（3.14±1.28）cm，肿瘤最小径由（2.80±0.88）cm降为（1.93±1.00）cm，差异均有统计学意义（t值分别为5.11、6.73，P值均＜0.05）。 Kaplan-Meier生存曲线分析得出术后平均生存时间（9.9±0.7）个月。结论经皮胆道支架联合125 I粒子植入术在延长患者生存时间、支架通.时间及改善患者生存质量方面近期疗效确切，具有安全、简便、创伤小、无绝对禁忌证及可反复应用等优点。
목적：초보연구경피담도지가연합125 I입자강내식입치료악성경조성황달적림상효과。방법선택실거근치성수술궤회혹불원행수술치료적악성경조성황달환자32례，시행경피담도지가연합125 I입자식입술，초보분석기림상효과。환자술전행생화상규、혈상규、종류표지물、응혈공능、간담이비채색초성、CT급MR담이관성상（ MRCP）등검사，명학환자일반정황、종류대소、범위급경조부위。선재B초인도하행경피경간담관인류（ PTCD），1주후재DSA하시행경피담도지가식입。근거술중조영현시지가적즉각확장정황，선택동시혹분기행125 I입자식입술。입자식입후1주、1개월、3개월행생화상규검사급DSA하담관조영，채용중복측량적방차분석방법비교술전여술후간공능지표수평변화정황；동시관찰125 I입자유무이위、탈락급지가통.정황。술후3개월경CT측량종류체적。종류체적술전여술후변화정황채용배대t검험。결과32례환자경치료후일반신체상황명현개선，황달소퇴명현。술후1주，혈청총담홍소수평（TBIL）유술전（302±169）μmol/L강지（108±50）μmol/L，혈청직접담홍소수평（DBIL）유술전（250±160）μmol/L강지（85±43）μmol/L，차이유통계학의의（F 치분별위76.32、58.23，P 치균＜0.01）。술후3개월，종류최대경유술전（3.78±1.14）cm강위（3.14±1.28）cm，종류최소경유（2.80±0.88）cm강위（1.93±1.00）cm，차이균유통계학의의（t치분별위5.11、6.73，P치균＜0.05）。 Kaplan-Meier생존곡선분석득출술후평균생존시간（9.9±0.7）개월。결론경피담도지가연합125 I입자식입술재연장환자생존시간、지가통.시간급개선환자생존질량방면근기료효학절，구유안전、간편、창상소、무절대금기증급가반복응용등우점。
Objective To evaluate the clinical application of the treatment on malignant obstructive jaundice by combination of percutaneous biliary stent placement and 125 I particles intraluminal implanation.Methods As a prospective study , 32 patients with malignant obstructive jaundice who either have no opportunity for radical operations or unwilling to be surgically treated were enrolled to be treated with percutaneous biliary stent placement and 125 I particles intraluminal implanation.Biochemical routine tests , blood routine tests , tumor markers , coagulation function , color ultrasound , CT and magnetic resonance cholangiopancreatography were conducted prior to the operation to obtain general information of the clinical status of the patients and the tumor and the site of obstruction.Percutaneous transhepatic cholangial drainage was performed first under the B -type ultrasound system.After one week , biliary stents were placed under DSA.According to the stent expansion presented by real-time DSA imaging , 125 I particles were implanted simultaneously or afterwards.Routine biochemical tests and cholangiopancreatography under DSA were conducted in one week , one month and three months after the implantation.Variance analysis was performed with repeated measurements to compare the difference of liver function indexes pre -and post-operation.Meanwhile, 125I particle displacement, falling off and stent patency were observed.After three months, the tumor size was measured by CT.Student t-test was used to compare the tumor sizes of pre-and post-operation.Results The symptoms of jaundice resolved and the general physical conditions improved in 32 patients substantially.The total bilirubin level decreased from preoperative level of (302 ±169)μmol/l to the level of (108 ±50)μmol/l at one week following the surgery , and the indirect bilirubin level decreased from preoperative level of ( 250 ±160 )μmol/l to the level of ( 85 ±43 )μmol/l at one week following the surgery(F=76.32,58.23,P<0.01).The maximal diameters of the tumors decreased from preoperative size of (3.78 ±1.14)cm to the size of (3.14 ±1.28)cm at three months following the surgery, and the minimal diameters of the tumors decreased from preoperative size of ( 2.80 ±0.88 ) cm to the size of ( 1.93 ± 1.00)cm at three months following the surgery, and the differences were statistically significant (t=5.11, 6.73,P<0.05).By using Kaplan-Meier survival curve, the average survival periods were ( 9.9 ± 0.7) months.Conclusions Percutaneous biliary stent placement and 125 I particles intraluminal implanation have definite short-term effects in prolonging survival time , stent patency time and improving the living standard of the patients.The technique is safe and simple.It only needs small incision , has no absolute contraindications and can be applied repeatedly .