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目的探讨表阿霉素治疗恶性梗阻性黄疸(MOJ)的安全性和可行性。方法39例 MOJ患者接受胆道支架置放术或经皮穿肝胆道引流术(PTBD)后,血清胆红素未降至正常水平即接受动脉化疗栓塞术(TACE)。TACE方案:法玛新30 mg／m2和超液化碘油混合成乳剂。参照WHO抗癌药物毒性分级标准观察毒性反应,Child-Push分级观察肝脏损害。随访患者黄疸复发时间和生存期。结果39例MOJ患者TACE术前血清总胆红素浓度为52．1-91．4μmol／L,中位值72．7μmol／L。表阿霉素总量40-60 mg,中位值55．0 mg,超液化碘油2-25 ml。白细胞计数下降:Ⅰ度41．0％,Ⅱ度35．9％,Ⅲ-Ⅳ度15．4％;恶心呕吐:Ⅲ-Ⅳ度100％。肝脏Child-Pugh分级:8例由A级升至 B级,1例由A级升至C级,3例由B级升至C级。全部患者未出现心脏毒性。39例患者的生存期为 2-72个月,中位值6．0个月。19例黄疸复发,复发率48．7％,黄疸复发时间2-20个月,中位值9．0 个月。结论 MOJ患者行有效引流后,即使胆红素未降至正常水平,用30 mg／m2表阿霉素和超液化碘油乳剂进行单纯化疗栓塞治疗原发病灶是安全和有效的。
Objective To investigate the safety and feasibility of epirubicin in the treatment of malignant obstructive jaundice (MOJ). Methods Thirty-nine patients with MOJ received transcatheter arterial chemoembolization (TACE) after they had undergone biliary stenting or percutaneous transhepatic biliary drainage (PTBD) without lowering serum bilirubin to normal levels. TACE program: Famax 30 mg / m2 and ultra liquefied lipiodol mixed into an emulsion. Toxicity was observed with reference to the toxicity classification standard of WHO anticancer drugs, and Child-Push grading was used to observe the liver damage. Patients were followed up for jaundice recurrence time and survival. Results The total serum bilirubin concentration of TACE in 39 patients with MOJ was 52.1-91.4μmol / L and the median was 72.7μmol / L. Total epirubicin 40-60 mg, median 55.0 mg, ultra-liquefied lipiodol 2-25 ml. White blood cell count decreased: Ⅰ degree 41.0%, Ⅱ degree 35.9%, Ⅲ-Ⅳ degree 15.4%; nausea and vomiting: Ⅲ-Ⅳ degree 100%. Liver Child-Pugh grading: 8 cases from grade A to grade B, 1 case from grade A to grade C, 3 cases from grade B to grade C. All patients did not show cardiotoxicity. 39 patients with survival of 2-72 months, a median of 6.0 months. 19 cases of jaundice recurrence, the recurrence rate was 48.7%, jaundice recurrence time 2-20 months, a median of 9.0 months. Conclusion After effective drainage of MOJ patients, the treatment of primary lesions with chemoembolization with epirubicin 30 mg / m2 and ultra-liquefied iodized oil emulsion is safe and effective even though bilirubin is not reduced to normal levels.