关键词: 恶性梗阻性黄疸, 经皮经肝胆管引流, 胆道支架, ¹²⁵ I 粒子, 治疗

Abstract: Objective To investigate the clinical effects of ¹²⁵I seed implantation at base of biliary stenting for the treatment of patients with malignant obstructive jaundice(MOJ). Methods 96 MOJ patients were admitted to our hospital from June 2015 to October 2017, and 55 patients out of them in the control group underwent percutaneous transhepatic bile duct drainage (PTCD) followed by biliary stent implantation and 45 patients in the observation group underwent PTCD followed by biliary stent implantation and ¹²⁵I particle implantation. The liver function indexes,including total bilirubin (TBIL), serum alanine aminotransferase (ALT), and serum aspartate aminotransferase (AST) ] and serum tumor marker CA199 levels before and 1 month after operation, the recent clinical efficacy, survival and postoperative complications in the two groups were compared. Results The interventional operation in the 96 patients was all successful; there were no obvious bleeding, peritonitis, biliary tract perforation, enteritis, biliary tract infection, reduction of white blood cell counts, nausea, vomiting and other complications in the two groups after operation; one month after surgery, serum bilirubin levels in the observation group and in the control group were (32.6±19.2) μmol / Lvs. (107.8±20.2) μmol / L, serum direct bilirubin levels were (23.4±12.4) μmol / L vs (97.4±12.5) μmol / L, serum ALT levels were (30.4±16.5)U/L vs. (85.9±19.8)U/L, serum AST levels were (30.7±13.2)U/L vs. (71.4±18.9)U/L, and serum CA199 levels were (30.7±13.2)U/L vs. (71.4±18.9)U/L, with significant differences between the two groups (all P <0.05); the average postoperative biliary patency in the observation group was (6.4±3.8) months, which was significantly longer than that in the control group [(2.9±1.8) months, P <0.05]; the total effective rate in the observation group was 53.7%, which was significantly higher than that in the control group (30.9%, P <0.05); the median survival time in the observation group was 10.7 months, which was significantly longer than that in the control group (6.2 months, P＜0.05). Conclusion The combination of biliary stent and ¹²⁵I seed implantation is an alternative option for patients with MOJ, with the subsidence of jaundice, inhibition of tumor growth, which might prolong the survival time of patients.

Key words: Malignant obstructive jaundice, Percutaneous transhepatic cholangial drainage, Biliary stent, ¹²⁵I seed implantation, Therapy