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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2023, Vol. 11 ›› Issue (01) : 48 -54. doi: 10.3877/cma.j.issn.2095-5782.2023.01.009

肿瘤介入

可移动125I粒子条联合经皮肝胆管内外引流术治疗肝门部胆管癌的临床价值
李衡1, 吴清华2,†(), 刘昌贺1, 袁艺文1, 吕正颀3   
  1. 1. 550004　贵州贵阳，贵州医科大学附属医院介入科
    2. 214121　江苏无锡，江南大学附属医院介入科
    3. 214122　江苏无锡，江南大学无锡医学院
  • 收稿日期:2022-08-29 出版日期:2023-02-25
  • 通信作者: 吴清华
  • 基金资助:
    太湖高层次人才项目(BJ2020048); 无锡市卫健委妇幼科研面上项目(FYKY201902); 无锡市转化医学研究所项目(LCYJ202221)

Clinical value of movable 125I radioactive particle strip combined with percutaneous transhepatic cholangiodrainage in the treatment of hilar cholangiocarcinoma

Heng Li1, Qinghua Wu2,†(), Changhe Liu1, Yiwen Yuan1, Zhengqi Lv3   

  1. 1. Department of Intervention, Affiliated Hospital of Guizhou Medical University, Guizhou Guiyang 550004
    2. Department of Intervention, Affiliated Hospital of Jiangnan University, Jiangsu Wuxi 214121
    3. Wuxi School of Medicine, Jiangnan University, Jiangsu Wuxi 214122, China
  • Received:2022-08-29 Published:2023-02-25
  • Corresponding author: Qinghua Wu
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李衡, 吴清华, 刘昌贺, 袁艺文, 吕正颀. 可移动125I粒子条联合经皮肝胆管内外引流术治疗肝门部胆管癌的临床价值[J]. 中华介入放射学电子杂志, 2023, 11(01): 48-54.

Heng Li, Qinghua Wu, Changhe Liu, Yiwen Yuan, Zhengqi Lv. Clinical value of movable 125I radioactive particle strip combined with percutaneous transhepatic cholangiodrainage in the treatment of hilar cholangiocarcinoma[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2023, 11(01): 48-54.

目的

探讨可移动125I粒子条联合经皮肝胆管内外引流术（percutaneous transhepatic cholangiodrainage，PTCD）治疗肝门部胆管癌（hilar cholangiocarcinoma，HCCA）的短期临床疗效。

方法

回顾性分析江南大学附属医院2020年7月—2021年9月收治的HCCA患者40例为研究对象，根据其不同的手术方式分为观察组（19例）与对照组（21例）。观察组采用可移动放射性125I粒子条联合PTCD的治疗方法，对照组采用直型125I粒子条联合胆道支架治疗。对比分析2组患者术前及术后的肝功能改善情况、引流通畅时间、手术时间、手术费用、术后并发症发生率、短期生存期等。

结果

2组患者在治疗后，肝功能异常指标均较治疗前明显降低，肝功能缓解程度无明显差异（P > 0.05）。观察组患者的引流通畅时间167.0 d优于对照组的152.0 d；两组胆道感染发生率分别为15.79%及61.90%，存在统计学意义（P = 0.01）。两组患者的手术时间及费用比较：观察组较对照组中位手术时间缩短大约20 min，中位手术费用少大约3 000元；观察组术后并发症发生率明显低于对照组（P值均< 0.05）。两组患者术后随访6~20个月，中位随访时间为13个月，观察组患者粒子条更换次数共18人次，短期生存率高于对照组（78.95% vs 52.38%）。

结论

可移动125I放射性粒子条植入联合PTCD治疗HCCA患者总体安全有效，手术时间缩短，胆道感染发生率更低，短期生存率更高。

关键词: 肝门部胆管癌, 可移动125I粒子条, PTCD, 近期疗效, 临床价值
Objective

To investigate the clinical efficacy of movable 125I particle strip combined with percutaneous transhepatic cholangiodrainage (PTCD) in the treatment of Hilar Cholangiocarcinoma (HCCA).

Methods

Forty HCCA patients were retrospective analyzed as the research objects from Affiliated Hospital of Jiangnan University from October 2020 to October 2021, and they were divided into the study group (19 cases) and the control group (21 cases) according to the different treatment. Patients in study group were treated by movable 125I radioactive seed implantation combined with PTCD, and the control group patients were treated by straight 125I radioactive seed implantation combined with percutaneous biliary stenting. The improvement of liver function before and after surgery, time to drainage patency, operation time, operation cost, incidence of postoperative complications and short survival time were compared and analyzed between the two groups.

Results

After treatment, the indexes of abnormal liver function in both groups were significantly lower than those before treatment. There was no significant difference in the remission of liver function between the two groups (P > 0.05). The drainage patency time of the study group was 167.0 d better than that of the control group (152.0 d). The incidence of biliary tract infection was 15.79% and 61.90% in the two groups, respectively, which was statistically significant.The median operation time in the study group was about 20 minutes shorter than that in the control group, and the median operation cost in the study group was about 3 000 yuan less than that in the control group,and the incidence of postoperative complications in the study group was significantly lower than that in the control group (all P < 0.05). Patients in two groups were followed up for 6 to 20 months, and the median follow-up time was 13 months. The total number of particle strip changes in the observation group was 18, and short-term survival rate was higher than that of the control group (78.95% vs 52.38%).

Conclusions

Movable 125I radioactive seed strip implantation combined with PTCD is generally safe and effective in the treatment of HCCA patients, with shorter operative time, lower incidence of biliary tract infections, and higher short-term survival rates.

Key words: Hilar cholangiocarcinoma, Movable 125I radioactive seed strip, Percutaneous transhepatic cholangiodrainage, Short-term efficacy, Value of clinical
表1 两组患者的一般资料对比[n（%）]
组别 例数 性别 年龄 Bismuth分型 Child-Pugh评分
男 女 Ⅰ型 Ⅱ型 Ⅲ型 Ⅳ型 A B C
观察组 19 12（63.2） 7（36.9） 62.9 ± 10.6 7（36.9） 4（21.1） 7（36.9） 1（5.3） 2（10.5） 11（57.9） 6（31.6）
对照组 21 14（66.7） 7（33.3） 60.5 ± 12.1 7（33.3） 3（14.3） 9（42.9） 2（9.5） 4（19.0） 12（57.1） 5（23.8）
P值 0.85 0.25 0.46 0.53
图1 根据患者肝右胆管的梗阻情况，按照TPS制定粒子置入数量发挥最佳放射剂量
图2 患者男，61岁，肝门部胆管癌，接受可移动粒子条联合PTCD治疗2A：经皮肝穿刺胆道造影示狭窄累及肝右胆管；2B：测量狭窄段长度，在狭窄段置入PTCD内外引流管内及固定125I粒子条。
图3 患者男，65岁，肝门部胆管癌，接受直型125I粒子条联合胆管支架治疗3A：经皮肝穿刺胆道造影示肝门部胆管未见明显扩张显影；3B：经球囊导管扩张狭窄段后，经导丝置入胆管支架及固定125I粒子条。
表2 两组患者术后并发症比较
组别 例数 腹痛 发热 出血 胆汁瘘 胆道感染
观察组 19 6 3 2 0 3
对照组 21 15 13 9 5 13
P值 0.02 0.01 0.03 0.04 0.01
图4 可移动粒子条联合PTCD组与粒子条联合胆道支架组Kaplan-Meier曲线比较
表3 2组患者治疗前后的肝功能异常指标的变化（±s）
指标 观察组（n = 19） 对照组（n = 21）
术前 术后 t值 P值 术前 术后 t值 P值
TBIL（μmol/L） 196.94 ± 30.35 93.23 ± 26.13 6.424 < 0.01 192.19 ± 28.84 91.09 ± 21.37 4.416 < 0.01
AST（U/L） 115.11 ± 14.89 40.79 ± 5.62 5.079 < 0.01 117.52 ± 16.49 43.38 ± 6.43 3.351 < 0.01
ALT（U/L） 111.32 ± 19.05 31.53 ± 5.73 4.480 < 0.01 112.76 ± 21.77 30.86 ± 4.67 5.638 < 0.01
ALP（U/L） 499.84 ± 69.19 216.05 ± 21.54 4.321 < 0.01 492.19 ± 67.41 217.76 ± 15.69 3.021 < 0.01
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