中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2014年
11期
864-867
,共4页
虞希祥%罗雅%乔彬彬%王舒婷%施振静%施昌盛%朱国庆%郑冰汝%王玉斌
虞希祥%囉雅%喬彬彬%王舒婷%施振靜%施昌盛%硃國慶%鄭冰汝%王玉斌
우희상%라아%교빈빈%왕서정%시진정%시창성%주국경%정빙여%왕옥빈
胆管,肝内%抗肿瘤联合化疗方案%恶性梗阻%支架术后再阻塞%放射学,介入性
膽管,肝內%抗腫瘤聯閤化療方案%噁性梗阻%支架術後再阻塞%放射學,介入性
담관,간내%항종류연합화료방안%악성경조%지가술후재조새%방사학,개입성
Bile ducts,intrahepatic%Antineoplastic combined chemotherapy protocols%Obstruction,malignant%Stent restenosis%Radiology,interventional
目的 探讨肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)或三维适形放疗(three dimensional comformal radiotherapy,3D-CRT)防治恶性胆道梗阻支架置入术后再阻塞的临床意义.方法 45例胆道恶性梗阻患者随机分为3组(各15例).A组为TACE组,采用经皮肝穿刺胆道内外引流(percutaneous transhepatic cholangial drainage,PTCD)及支架置入加TACE治疗;B组为放疗组,采用PTCD及支架置入加3D-CRT;C组为对照组,仅采用PTCD及支架置入治疗.支架置入术后1、2、3、4个月分别经引流道行胆管和支架内活检术,针对阻塞原因给予相应处理,肉芽组织增生采用更换引流管或再次置入支架;肿瘤生长采用再次TACE或放疗.结果 A组患者平均维持通畅时间102 d;支架内肉芽组织增生4例,肿瘤生长2例.B组平均维持通畅时间94 d;支架内肉芽组织增生2例,肿瘤生长1例.C组平均维持通畅时间51d;支架内肉芽组织增生3例,肿瘤生长6例.A组、B组和C组3个月生存率分别为93％、87％和60％;6个月生存率分别为60％、47％和20％;9个月生存率分别为20％、13％和0.结论 恶性胆道梗阻支架置入术后再阻塞,早期与肌成纤维细胞活性增强相关,后期与肿瘤生长相关,TACE或3D-CRT能有效防治支架内肿瘤生长所致的再阻塞.
目的 探討肝動脈化療栓塞術(transcatheter arterial chemoembolization,TACE)或三維適形放療(three dimensional comformal radiotherapy,3D-CRT)防治噁性膽道梗阻支架置入術後再阻塞的臨床意義.方法 45例膽道噁性梗阻患者隨機分為3組(各15例).A組為TACE組,採用經皮肝穿刺膽道內外引流(percutaneous transhepatic cholangial drainage,PTCD)及支架置入加TACE治療;B組為放療組,採用PTCD及支架置入加3D-CRT;C組為對照組,僅採用PTCD及支架置入治療.支架置入術後1、2、3、4箇月分彆經引流道行膽管和支架內活檢術,針對阻塞原因給予相應處理,肉芽組織增生採用更換引流管或再次置入支架;腫瘤生長採用再次TACE或放療.結果 A組患者平均維持通暢時間102 d;支架內肉芽組織增生4例,腫瘤生長2例.B組平均維持通暢時間94 d;支架內肉芽組織增生2例,腫瘤生長1例.C組平均維持通暢時間51d;支架內肉芽組織增生3例,腫瘤生長6例.A組、B組和C組3箇月生存率分彆為93％、87％和60％;6箇月生存率分彆為60％、47％和20％;9箇月生存率分彆為20％、13％和0.結論 噁性膽道梗阻支架置入術後再阻塞,早期與肌成纖維細胞活性增彊相關,後期與腫瘤生長相關,TACE或3D-CRT能有效防治支架內腫瘤生長所緻的再阻塞.
목적 탐토간동맥화료전새술(transcatheter arterial chemoembolization,TACE)혹삼유괄형방료(three dimensional comformal radiotherapy,3D-CRT)방치악성담도경조지가치입술후재조새적림상의의.방법 45례담도악성경조환자수궤분위3조(각15례).A조위TACE조,채용경피간천자담도내외인류(percutaneous transhepatic cholangial drainage,PTCD)급지가치입가TACE치료;B조위방료조,채용PTCD급지가치입가3D-CRT;C조위대조조,부채용PTCD급지가치입치료.지가치입술후1、2、3、4개월분별경인류도행담관화지가내활검술,침대조새원인급여상응처리,육아조직증생채용경환인류관혹재차치입지가;종류생장채용재차TACE혹방료.결과 A조환자평균유지통창시간102 d;지가내육아조직증생4례,종류생장2례.B조평균유지통창시간94 d;지가내육아조직증생2례,종류생장1례.C조평균유지통창시간51d;지가내육아조직증생3례,종류생장6례.A조、B조화C조3개월생존솔분별위93％、87％화60％;6개월생존솔분별위60％、47％화20％;9개월생존솔분별위20％、13％화0.결론 악성담도경조지가치입술후재조새,조기여기성섬유세포활성증강상관,후기여종류생장상관,TACE혹3D-CRT능유효방치지가내종류생장소치적재조새.
Objective To evaluate transcatheter arterial chemoembalization (TACE)and/or threedimentional radiotherapy for the prevention of stent restenosis in patients of malignant biliary obstruction.Methods In this series,45 cases of malignant biliary obstruction after stent placement were randomly divided into three groups,15 cases in each group.Group A patients received TACE management,patients in group B were treated with three-dimensional conformal radiotherapy,patients in group C received supportive therapy.On 1,2,3,4 months after stent placement,intra-stent biopsy was performed,obstruction was managed by stent replacement.Results Time of stent patence was 102,94 and 51 days respectively in group A,B,and C.3 months survival rate was 93％,87％ and 60％ respectively; 6 months survival rate was 60％,47％ and 20％ respectively; 9 months survival rate was 20％,13％ and 0 respectively.Conclusions For malignant biliary obstruction after biliary tract stenting,TACE and or 3D radiation therapy can effectively prevent stent restenosis caused by tumor growth.
