CAJ | 학술논문

目的：研究恶性胆道梗阻患者在施行经皮胆道支架成形术的基础上，经胆道支架内植入放射性粒子条治疗恶性胆道梗阻的疗效。方法38例恶性胆道梗阻的患者，应用125I 粒子，每个125I 粒子长4．5 mm、直径0．8 mm，送入导管制备粒子条。先行经皮胆道引流术（PTCD）术；将导丝经皮通过梗阻段，先行球囊导管扩张，后行经皮胆道支架成形术；然后经支架置入8～10 F 胆道引流管；最后将装有粒子条的导管在透视下经胆道引流管送入所需照射部位，包敷固定引流管露出体外部分或者包埋于皮下。结果38例胆道恶性梗阻的患者中36例成功施行经皮胆道支架成形术及放射性粒子条植入术，术后患者血清胆红素均降至正常或接近正常（P <0．05）。未出现明显不良反应。结论临床观察发现经皮胆道支架成形术后联合放射性粒子条置入术治疗恶性胆道梗阻是一种安全有效的方法。
목적：연구악성담도경조환자재시행경피담도지가성형술적기출상，경담도지가내식입방사성입자조치료악성담도경조적료효。방법38례악성담도경조적환자，응용125I 입자，매개125I 입자장4．5 mm、직경0．8 mm，송입도관제비입자조。선행경피담도인류술（PTCD）술；장도사경피통과경조단，선행구낭도관확장，후행경피담도지가성형술；연후경지가치입8～10 F 담도인류관；최후장장유입자조적도관재투시하경담도인류관송입소수조사부위，포부고정인류관로출체외부분혹자포매우피하。결과38례담도악성경조적환자중36례성공시행경피담도지가성형술급방사성입자조식입술，술후환자혈청담홍소균강지정상혹접근정상（P <0．05）。미출현명현불량반응。결론림상관찰발현경피담도지가성형술후연합방사성입자조치입술치료악성담도경조시일충안전유효적방법。
Objective To investigate the clinical efficacy of percutaneous transhepatic insertion of biliary stent (PTIBS) combined with radioactive seed implantation in treating malignant biliary obstruction. Methods A total of 38 patients with malignant biliary obstruction were enrolled in this study. Radioactive 125I seed was used, and each 125I seed was 4.5 mm in length and 0.8 mm in diameter. The 125I seeds were placed in a catheter to prepare the 125I seed- strip. PTCD was carried out first, then percutaneous catheterization was performed and a guide- wire was inserted through the catheter until it passed the obstructed biliary segment. The obstructed segment was dilated by a balloon - catheter, which was followed by PTIBS. An 8 - 10 F drainage - catheter was placed into the biliary duct through the stent. Finally, guided by fluoroscopy the catheter with the 125I seed- strip was inserted via the drainage- catheter to the area that was planned to be radiated. The external drainage- catheter was wrapped and fixed to the skin, or was imbedded under the skin. Results Of the 38 patients with malignant biliary obstruction, successful PTIBS combined with radioactive seed implantation was accomplished in 36 patients. After the treatment, the serum bilirubin level fell to normal or near normal range in all patients (P < 0.05). No obvious side effects were observed. Conclusion For the treatment of malignant biliary obstruction, percutaneous transhepatic insertion of biliary stent combined with radioactive 125I seed - strip implantation is a safe and effective method.