| Objective:(1)To explore the efficacy and safety of biliary stent combined with 125 I particle strip implantation in the treatment of high-grade malignant biliary obstruction.(2)Compared with simple biliary stent implantation in terms of effectiveness and safety.Methods: A retrospective analysis of patients with high-grade malignant biliary obstruction admitted in the Interventional Department of the Affiliated Tumor Hospital of Guangxi Medical University from January 2017 to January2019,we selected 45 patients who met the requirements.Among these 45 patients,31 were male,14 were female,and the age was 31-77 The average age is 52 years old,including 20 cases of cholangiocarcinoma,13 cases of liver cancer,and 12 cases of metastatic cancer.All of the above were confirmed as malignant tumors by B-ultrasound,CT,or MRI,and there was significant intrahepatic bile duct dilation.After meeting and discussing in the department,two treatment options(biliary tract stent combined with 125 I particle strip placement or simple biliary stent placement)were given and the patients and their families chose according to their own wishes.All patients underwent PTCD,according to whether or not to place particle strips Divided into experimental group(n=23)and control group(n=22).Twenty-three patients who received 125 I radioactive particle strips + biliary stent implantation were the experimental group,and the remaining 22 patients who refused 125 I particle strip implantation for various reasons were the control group.Follow up the patients after treatment and compare the changes of laboratory indexes such as total bilirubin and direct bilirubin before and after operation,patency of stents,average survival time of postoperative patients and postoperative complications in the two groups of patients Happening.Results: All 45 patients were successfully operated.There were 2 cases of biliary tract infection after operation,including 1 case in the experimental group and 1 case in the control group,the difference was not statistically significant(p>0.05).There was 1 case of biliary hemorrhage,including 0 cases in the experimental group and 1 case in the control group.The difference was not statistically significant(p>0.05).There was 1 case of bile leakage in the puncture mouth,including 1 case in the experimental group and 0 case in the control group,and the difference was not statistically significant(p>0.05).There was 1 case of ascites puncture,including 0 cases in the experimental group and1 case in the control group.The difference was not statistically significant(p>0.05).There were 3 cases of biliary pancreatitis,2 cases in the experimental group and 1 case in the control group.The difference was not statistically significant(p>0.05).There were no postoperative complications such as gallbladder reflex,drainage tube blockage,stent and particle strip displacement.Comparison of laboratory indicators such as total bilirubin,direct bilirubin,and serum albumin at 4 weeks postoperatively in the two groups showed that the TBIL of the experimental group and the control group decreased to(43.9±10.1)umol/L,(45.7±9.5)Umol/L,DBIL decreased to(28.3±9.6)umol/L,(32.0±9.3)umol/L,ALT decreased to(51.7±14.0)IU/L,(44.8±10.0)IU/L,ALB respectively Increased to(34.7±1.4)g/L and(35.1±1.9)g/L respectively.Compared with preoperative and postoperative,the difference was statistically significant(p<0.05);but the difference between the experimental group and the control group was not statistically significant(p>0.05).CA19-9 decreased to(642.6±253.4)ng/ml and(571.2±266.2)ng/ml at 4 weeks after operation.There was no statistically significant difference between preoperative and postoperative(p>0.05),between the two groups The contrast difference was also not statistically significant(p>0.05).The average stent patency time of the experimental group was 8.9±0.6 months;the average stent patency time of the control group was 6.2±0.5 months,the difference was statistically significant(P<0.01);the average survival time of the experimental group patients was11.3± At 0.7 months,the average survival time of the control group was 8.5±0.5months.The average survival time of the experimental group was significantly longer than that of the control group.The difference was statistically significant(X2=9.684,p=0.002).Conclusions: 1.Treatment of patients with high-grade malignant biliary obstruction by biliary stent combined with 125 I radioactive particle strip implantation can alleviate jaundice and promote liver function recovery.There is no significant difference in the 30-day efficacy compared with patients who simply undergo biliary stent implantation.2.Compared with simple biliary stent implantation,biliary stent combined with 125 I radioactive particle strip implantation can improve stent patency rate,prolong stent patency time and survival time.3.Compared with simple biliary stent implantation,biliary stent combined with 125 I radioactive particle strip implantation does not increase the risk of complications after surgery. |
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