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目的观察单纯球囊扩张、胆道外引流同时行~(125)I粒子链植入治疗恶性胆道梗阻的疗效。方法 4例恶性胆道梗阻患者,分别为胆管癌1例,肝癌介入治疗术后1例,肝癌手术切除后胆管内癌栓1例,胰头癌1例,术前总胆红素分别为230μmol/L、450μmol/L、670μmol/L和280μmol/L;采用经皮胆道穿刺途径行胆道球囊扩张、外引流,而不放置胆道支架;同时行胆管内~(125)I粒子链植入。结果 4例患者经皮外引流及~(125)I粒子链植入操作均顺利完成。术后14～19 d总胆红素降至接近正常水平,术后10～23 d拔除外引流管,分别随访6、5、4.5和4个月无黄疸复发;3例仍生存,1例胰腺癌患者术后6.5个月死于全身衰竭。结论单纯球囊扩张、胆道外引流并~(125)I粒子链植入消褪黄疸疗效显著,有获得较长时间胆管开通的可能,值得进一步探讨。
Objective To observe the curative effect of simple balloon dilatation and extra-biliary drainage in the treatment of malignant biliary obstruction with ~ (125) I particle chain implantation. Methods One case of cholangiocarcinoma, one case of hepatocellular carcinoma after interventional therapy, one case of intrahepatic cholangiocarcinoma after resection of hepatocellular carcinoma and one case of pancreatic carcinoma were included in the study. Among the four cases, malignant biliary obstruction was cholangiocarcinoma, preoperative total bilirubin was 230μmol / L, 450μmol / L, 670μmol / L and 280μmol / L. The percutaneous cholangiopancreatic approach was used to perform biliary balloon dilatation and external drainage without placing biliary stents. Results Four patients were successfully treated with percutaneous drainage and ~ (125) I particle chain implantation. Total bilirubin decreased to nearly normal level from 14 to 19 days after operation, and external drainage tube was removed 10 to 23 days after operation. No recurrence of jaundice was observed at 6, 5, 4.5 and 4 months after operation. Three patients survived and one case of pancreas Cancer patients die of systemic failure 6.5 months after surgery. Conclusions The simple balloon dilatation, extrahepatic drainage and ~ (125) I particle chain implants have a significant curative effect on jaundice. It is worth to further explore the possibility of prolonged open bile duct.