Comparison Of The Efficacy Of ¹²⁵I Seed-strip Combined With Percutaneous Biliary Stent Implantation And Biliary Stent Implantation In The Treatment Of Malignant Biliary Obstruction

Objective:To retrospectively analyze the efficacy and safety of ¹²⁵I seed-strip combined with percutaneous biliary stent implantation and biliary stent implantation in the treatment of malignant biliary obstruction.·Methods:Collected from January 2012 to August 2017,I division hospitalize of 65 patients with malignant biliary obstruction,a radical resection opportunities have been lost,one group is ¹²⁵I seed-strip combined with biliary stent implantation treatment of 39 cases(¹²⁵I seed-strip of stent group),the other one is biliary stents treatment of 26 cases ?biliary stent group?.Two groups are first percutaneous transhepatic biliary drainage?PTCD?,and postoperative 1 week,according to CT,MR and intraoperative angiography confirmed biliary obstruction position and size of tumor,implanting the required specifications of the biliary stents,¹²⁵I seed-strip of stent group needs to implant ¹²⁵I seed-strip at the same time.1 week after operation,need to observe two groups of jaundiceandglutamic-pyruvictransaminase?ALT?,glutamicoxalacetic transaminase?AST?,total bilirubin?TBIL?and indirect bilirubin?DBIL?and other indicators;After 1 month,3 months and every 3 months of telephone follow-up,we learned whether jaundice,abdominal pain,fever,external drainage tube taking off and survival condition.Comparative analysis of the success rate of the two groups,the effective rate of releasing jaundice,the incidence of reobstruction,the time of survival,the time of stent patency,the incidence of complications and the incidence of adverse reactions.Results:All the patients in the ¹²⁵I seed-strip of stent group and the biliary stent group were successfully implanted with the biliary stent+¹²⁵I seed-strip and biliary stent respectively under DSA,and the success rate of the two groups was 100%.Recent curative effect:the effective rate of relieving biliary obstruction in the ¹²⁵I seed-strip of stent group was 97.44%?38/38?,the biliary stent group was 100%?26/26?,the difference was no statistically significant?p=0.41?.Long-term follow-up result:the reobstruction rate of biliary within 6-month of the ¹²⁵I seed-strip of stent group was 7.69%?3/39?,significantly lower than the 26.92%?7/26?of the biliary stent group,and the difference was statistically significant?p=0.035?.Mean survival time and mean stent patency time in the ¹²⁵I seed-strip of stent group was 10.7±0.87 months and 12.04±1.24 months respectively,mean survival time and mean stent patency in the biliary stent group was6.90±0.37 months and 6.5±0.38 months respectively,differences between the two groups was statistically significant?p<0.05?.Median survival time and the median stent patency time in the ¹²⁵I seed-strip of stent was 11.5 months and 9.0 months respectively,median survival time and median stent patency time in the biliary stent group was 7.0months and 8.0 months respectively,differences between the two groups was statistically significant?p<0.05?.The incidence of early complications of the ¹²⁵I seed-strip of stent group was 20.51%?8/39?,and the incidence of early complications in the biliary stent group was 15.38%?4/26?,and the difference between the two groups was not statistically significant?p=0.60?.The incidence of late-stage complications of ¹²⁵I seed-strip of stent group was 5.13%?2/29?,and the incidence of late-stage complications in the biliary stent group was 3.85%?1/26?,and the difference between the two groups was not statistically significant?p=0.81?.The incidence of adverse reactions in ¹²⁵I seed-strip of stent group was 17.95%?7/39?,and the incidence of adverse reactions in the biliary stent group was15.38%?4/26?,and the difference between the two groups was not statistically significant?p=0.79?.Conclusion:¹²⁵I seed-strip combined with percutaneous biliary stent implantation is a safe and effective treatment in the treatment of maglinant obstruction.