CAJ | 학술논문

目的探讨单纯胆道支架与支架联合125I粒子条植入腔内照射治疗恶性梗阻性黄疸的临床价值.方法对62例恶性阻塞性黄疸患者行经皮经肝胆管引流(PTCD)后随机分组:A组31例行胆道支架联合125I粒子条植入(实验组),B组31例行单纯胆道支架植入(对照组).比较两组患者术前、术后黄疸消退、复发情况、T淋巴细胞亚群变化以及生存时间.结果 A、B两组患者PTCD术前及支架植入术后1周血清总胆红素测定差异无统计学意义(P＞0.05).术后1个月、3个月血清总胆红素测定,A组优于B组(P＜0.05).随访期内,A组再次发生胆道梗阻1例,B组12例(P＜0.05).对比PTCD术前,A组术后1～2周CD4及CD4/CD8比值明显升高(P＜0.05),CD3变化无差异(P＞0.05).B组术后1～2周CD3、CD4及CD4/CD8比值变化无明显差异(P＞0.05).A组患者中位生存时间10.9个月,B组患者中位生存时间7.1个月,两组差异有统计学意义(P＜0.05).结论 125I粒子条联合胆道支架植入腔内照射治疗恶性梗阻性黄疸在黄疸消退、改善机体免疫机能及延长患者生存时间等方面均优于单纯胆道支架植入治疗.
목적 탐토단순담도지가여지가연합125I입자조식입강내조사치료악성경조성황달적림상개치.방법 대62례악성조새성황달환자행경피경간담관인류(PTCD)후수궤분조:A조31례행담도지가연합125I입자조식입(실험조),B조31례행단순담도지가식입(대조조).비교량조환자술전、술후황달소퇴、복발정황、T림파세포아군변화이급생존시간.결과 A、B량조환자PTCD술전급지가식입술후1주혈청총담홍소측정차이무통계학의의(P＞0.05).술후1개월、3개월혈청총담홍소측정,A조우우B조(P＜0.05).수방기내,A조재차발생담도경조1례,B조12례(P＜0.05).대비PTCD술전,A조술후1～2주CD4급CD4/CD8비치명현승고(P＜0.05),CD3변화무차이(P＞0.05).B조술후1～2주CD3、CD4급CD4/CD8비치변화무명현차이(P＞0.05).A조환자중위생존시간10.9개월,B조환자중위생존시간7.1개월,량조차이유통계학의의(P＜0.05).결론 125I입자조연합담도지가식입강내조사치료악성경조성황달재황달소퇴、개선궤체면역궤능급연장환자생존시간등방면균우우단순담도지가식입치료.
Objective To compare biliary stent versus combined biliary stent with intracavitary irradiation using 125I seed implantation to treat patients with malignant obstructive jaundice.Methods 62 patients with malignant obstructive jaundice after drainage with PTCD were randomized into two groups:Group A:biliary stent combined with 125I seed implantation (the treatment group),Group B:biliary stent alone (the control group).Postoperative change in jaundice,tumor recurrence,T lymphocyte subsets and survival time were compared between these two groups.Results The change in total serum bilirubin in the two groups of patients showed no significant difference at postoperative 1 month (P ＞ 0.05).However,Group A was better than Group B (P ＜ 0.05) at postoperative I month and 3 months.On follow-up,one patient developed recurrent biliary obstruction in Group A and 12 patients in Group B (P ＜ 0.05).When compared with the preoperative values,CD4 and the ratio of CD4/CD8 increased significantly in Group A at 1 to 2weeks postoperative (P ＜ 0.05),and there was no difference in CD3 (P ＞ 0.05).For patients in Group B,there were no significant difference in CD3,CD4 and CD4/CD8 ratio at 1 ～ 2 weeks postoperative when compared with the preoperative values (P ＞ 0.05).The median survival time for Group A was 10.9 months and for Group B 7.1 months (P ＜ 0.05).Conclusions Intracavitary irradiation using 125I seed implantation combined with biliary stent was better than stenting alone in the treatment of malignant obstructive jaundice.The combined treatment better relieved jaundice,improved immune function and prolonged survival time.