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目的 :探讨恶性梗阻性黄疸的内支架植入术后 ,动脉药盒植入术局部治疗的价值。材料和方法 :3 6例均已不能或不宜行外科手术治疗的恶性梗阻性黄疸病人 ,其中肝门区肿瘤 2 5例 (肝门原发性肝癌 12例 ,肝门转移性肝癌 13例 ) ,胰头癌 7例 ,胆管癌 4例 ,随机分两组 ,一组为单纯内支架治疗 (EMBE) ;另一组为EMBE加PCS治疗组。先行经皮胆管引流内支架植入术 ,然后行动脉药盒 (PCS)植入术 ,再按肿瘤生物特性及药代动力特点 ,经药盒泵入化疗药物。结果 :3 6例中 3 1例胆管引流内支架植入术成功 ,其中之 13例行单纯胆道内支架植入术 ,18例在胆道内支架植入术基础上行PCS植入术 ,随访 1～ 12个月 ,EMBE组 :1～ 3个月内 6例 ( 5 0 % )出现再闭塞。 2～ 6个月内死亡 8例 ,占 6 1 5 % ,12个月内死亡 11例 ,占 84 6 %。EMBE +PCS组 4( 2 2 2 % ) 1～ 3个月后出现再闭塞 ,2～ 6个月内死亡 6例 ,占 3 3 3 % ,12个月内死亡 9例 ,占 5 0 0 %。两组再闭塞率及死亡率相比 ,经t检验 ,P值<0 0 1,EMBE +PCS组与EMBE组有显著差异性。结论 :恶性梗阻性黄疸EMBE加PCS治疗优于单纯EMBE组 ,是一种较好的局部治疗方法
Objective : To investigate the value of local treatment for arterial medicine box implantation after internal stenting of malignant obstructive jaundice. Materials and Methods: Thirty-six patients with malignant obstructive jaundice who could not or could not be treated by surgery, including 25 cases of hepatic portal tumor (12 cases of hepatic portal carcinoma and 13 cases of hepatic metastatic liver cancer). There were 7 cases of pancreatic head cancer and 4 cases of cholangiocarcinoma. They were randomly divided into two groups. One group was treated with simple stenting (EMBE); the other group was treated with EMBE plus PCS. Percutaneous stenting for percutaneous bile duct drainage was performed first, followed by arterial PCS implantation. Then, according to the biological characteristics of the tumor and pharmacokinetic characteristics, the drug was pumped into the chemotherapeutic drugs. RESULTS: Of the 36 patients, 31 cases had successful bile duct drainage stent implantation. Among them, 13 cases underwent simple biliary stent implantation and 18 cases underwent PCS implantation along the bile duct stent implantation. Follow-up 1~ At 12 months, in the EMBE group, reocclusion occurred in 6 cases (50%) within 1 to 3 months. 8 cases died within 2 to 6 months, accounting for 61.5 percent, and 11 cases died within 12 months, accounting for 84.6%. EMBE + PCS group 4 (22%) appeared reocclusion after 1 to 3 months, 6 cases died within 2 to 6 months, accounting for 333%, 9 cases died within 12 months, accounting for 50% . Comparing the rate of reocclusion and mortality between the two groups, the t-test showed a significant difference between the EMBE + PCS group and the EMBE group. Conclusion: EMBE plus PCS treatment of malignant obstructive jaundice is better than EMBE alone. It is a better local treatment method.