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目的探讨胆道支架联合~(125)I粒子植入术治疗肝门区肿瘤合并梗阻性黄疸的疗效。方法回顾性分析研究行介入治疗的65例肝门区肿瘤并梗阻性黄疸患者,36例(对照组)单纯行胆道支架术;29例(观察组)联合CT引导下~(125)I粒子植入肝门区肿瘤。结果 2个月后,根据mRECIST标准计算近期有效率,观察组65.5%(PR 19例,CR 0例)明显优于对照组11.1%(PR 4例,CR 0例)(P<0.05)。支架术后4个月内两组再梗阻率无差异(P>0.5),而4个月后对照组明显高于观察组(P<0.05)。支架平均通畅时间:观察组(8.9±0.7)个月较对照组(6.3±0.5)个月长(P<0.05)。中位生存时间:观察组(12.0±1.1)个月较对照组(8.1±0.7)个月延长(P<0.05)。多因素分析显示:肝门区继发肿瘤(P=0.01);肝功能Child-Pugh分级(P=0.03);功能状态评分(PS评分)(P=0.00)是患者生存时间独立的预后因素。支架植入术和~(125)I粒子植入术均未出现严重并发症。结论肝门区肿瘤合并梗阻性黄疸,胆道支架联合~(125)I粒子瘤内照射的临床疗效优于单纯胆道支架组,且安全可行。
Objective To investigate the clinical effect of biliary stent combined with 125 I seed implantation in the treatment of hilar tumors in hilar region. Methods Sixty-five patients with hilar tumors and hilar obstructive jaundice were enrolled in this study. Twenty-six patients (control group) were treated with biliary stenting alone. Twenty-nine patients (observation group) and CT-guided 125 I seed implantation Into the portal area tumor. Results Two months later, the short-term effective rate was calculated according to the mRECIST criteria. 65.5% (PR 19, CR 0) of the observation group were significantly better than 11.1% of the control group (PR 4, CR 0) (P 0. 05). There was no difference in re-obstruction rate between the two groups within 4 months after operation (P> 0.5), but after 4 months, the control group was significantly higher than the observation group (P <0.05). The mean patency of the stent was (8.9 ± 0.7) months in the observation group (6.3 ± 0.5) months longer than that in the control group (P <0.05). Median survival time: The observation group (12.0 ± 1.1) months compared with the control group (8.1 ± 0.7) months (P <0.05). Multivariate analysis showed that secondary tumors in hilar region (P = 0.01), Child-Pugh classification of liver function (P = 0.03), and functional status score (PS = 0.00) were independent prognostic factors in patients’ survival time. Stent implantation and ~ (125) I particle implantation did not appear serious complications. Conclusions The curative effect of hilar tumor combined with obstructive jaundice and biliary stent combined with intraluminal 125I I tumor irradiation is better than that of pure biliary stent group, and it is safe and feasible.