<sup>125</sup>I放射性粒子条联合胆管金属支架植入术在恶性胆肠吻合口狭窄中的应用

doi:10.3877/cma.j.issn.2095-5782.2021.02.009

目的

评估¹²⁵I放射性粒子条联合胆管金属支架植入术在恶性胆肠吻合口狭窄患者治疗中的有效性及安全性。

方法

回顾性分析21例恶性胆肠吻合口狭窄并且行¹²⁵I放射性粒子条联合胆管金属支架植入术的患者，统计分析手术成功率、支架通畅时间、生存时间及手术并发症。

结果

胆肠吻合术后出现胆肠吻合口狭窄的中位时间为8（3～78）个月；其中，植入单枚支架患者14例，植入双枚支架患者7例，支架直径为8～10 mm，长度为40～80 mm，每个患者平均植入（17.43 ± 5.65）（10～30）枚¹²⁵I放射性粒子；术后总胆红素（TBIL）、直接胆红素（DBIL）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、谷草转氨酶（AST）、谷丙转氨酶（ALT）较术前均有所下降，且TBIL、DBIL、GGT、ALP下降水平有统计学意义（P < 0.05），其余指标的差异无统计学意义（P > 0.05）；患者术前术后肿瘤标记物甲胎蛋白（AFP）、癌胚抗原（CEA）、糖链抗原125（CA125）、癌抗原19-9（CA19-9）的变化无统计学意义（P > 0.05）。并发症方面，有4例患者在术后出现可控性少量胆道出血（19.0%，4/21），1例粒子条移位（4.8%，1/21），1例胆管支架断裂（4.8%，1/21）。胆管支架中位通畅时间为（121.00 ± 17.55） d （95%CI：86.61～155.39），患者中位生存时间（231.00 ± 45.61） d（95%CI：141.60～320.40）。

结论

¹²⁵I放射性粒子条联合胆管支架植入术治疗恶性胆肠吻合口狭窄具有良好的安全性及有效性。

关键词: 胆肠吻合口狭窄, ¹²⁵I放射性粒子, 胆管金属支架

Objective

To investigate the effectiveness and safety of biliary stenting combined with¹²⁵I seeds strand in treatment of malignant biliary-enteric anastomotic stricture.

Methods

21 patients with biliary-enteric anastomotic stricture treated by ¹²⁵I seeds strand combined with metallic stent implantation were analyzed retrospectively. The procedural success rate, stent patency time, survival time and complications were recorded.

Results

The median time of postoperative malignant biliary-enteric anastomotic stricture was 8 (3~78) months. 14 patients were implanted with single stent, 7 patients with double stents. The diameter of stents was (8~10) mm and the length of stents was (40~80) mm. The mean number of¹²⁵I implanted was (17.43 ± 5.65) (10~30). The levels of total bilirubin, direct bilirubin, alkaline phosphatase, gamma glutamyl peptidase, glutamic oxalacetic transaminase and glutamic pyruvic transaminase were lower post-operation than pre-operation, the decrease levels of total bilirubin, direct bilirubin, alkaline phosphatase, gamma glutamyl peptidase had significant statistical differences (P < 0.05), but the others had no statistical differences (P > 0.05). There werect no significant differences in tumor markers (AFP, CEA, CA125, CA199) before and after operation (P > 0.05). The complications include 4 cases (19.0%, 4/21) of controllable bleeding of bile duct, 1 case (4.8%, 1/21) of 125I seeds strand migration, 1 case (4.8%, 1/21) of bile duct stent fracture. The median stent patency time was (121.00 ± 17.55) (95%CI: 86.61~155.39) days and the median overall survival was (231.00 ± 45.61) (95%CI: 141.60~320.40) days.

Conclusions

¹²⁵I seeds strand combined with metallic stent implantation is safe and effective in the treatment of malignant biliary-enteric anastomotic stricture.

Key words: Biliary-enteric anastomotic stricture, ¹²⁵I seeds, Biliary metallic stent

图1 男，63岁，诊断胆管癌行胰十二指肠切除术，术后78个月出现胆肠吻合口狭窄

表1 患者术前术后生化数据对比

	TBIL（μmol/L）	DBIL（μmol/L）	GGT（U/L）	ALP（U/L）	AST（U/L）	ALT（U/L）
术前	100.95 ± 79.52	81.48 ± 69.37	579.57 ± 391.85	576.62 ± 349.95	85.43 ± 108.47	75.48 ± 85.37
术后	48.14 ± 43.67	34.31 ± 36.82	315.24 ± 209.80	358.24 ± 189.33	58.00 ± 34.85	55.33 ± 50.99
t值	3.772	3.854	3.863	3.565	1.133	0.908
P值	0.001	0.001	0.001	0.002	0.271	0.375

表1 患者术前术后生化数据对比

	TBIL（μmol/L）	DBIL（μmol/L）	GGT（U/L）	ALP（U/L）	AST（U/L）	ALT（U/L）
术前	100.95 ± 79.52	81.48 ± 69.37	579.57 ± 391.85	576.62 ± 349.95	85.43 ± 108.47	75.48 ± 85.37
术后	48.14 ± 43.67	34.31 ± 36.82	315.24 ± 209.80	358.24 ± 189.33	58.00 ± 34.85	55.33 ± 50.99
t值	3.772	3.854	3.863	3.565	1.133	0.908
P值	0.001	0.001	0.001	0.002	0.271	0.375

表2 患者术前术后肿瘤标记物变化

	AFP（ng/mL）	CEA（ng/mL）	CA125（U/mL）	CA19-9（U/mL）
术前	4.97 ± 5.59	3.18 ± 2.10	51.41 ± 44.47	856.57 ± 1 192.67
术后	3.38 ± 3.18	3.63 ± 2.46	94.21 ± 123.73	1 319.17 ± 1 885.66
t值	1.274	-0.889	-1.688	-1.758
P值	0.217	0.385	0.107	0.094

表2 患者术前术后肿瘤标记物变化

	AFP（ng/mL）	CEA（ng/mL）	CA125（U/mL）	CA19-9（U/mL）
术前	4.97 ± 5.59	3.18 ± 2.10	51.41 ± 44.47	856.57 ± 1 192.67
术后	3.38 ± 3.18	3.63 ± 2.46	94.21 ± 123.73	1 319.17 ± 1 885.66
t值	1.274	-0.889	-1.688	-1.758
P值	0.217	0.385	0.107	0.094

图2 Kaplan-Meier生存曲线显示125I放射性粒子条联合胆管支架植入术治疗恶性胆肠吻合口狭窄患者

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¹²⁵I seeds strand combined with biliary metallic stent in treatment of malignant biliary-enteric anastomotic stricture

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125I seeds strand combined with biliary metallic stent in treatment of malignant biliary-enteric anastomotic stricture

¹²⁵I seeds strand combined with biliary metallic stent in treatment of malignant biliary-enteric anastomotic stricture