Percutaneous biliary stent combined with brachytherapy for malignant obstructive jaundice: a multicenter retrospective controlled study
10.3760/cma.j.cn501113-20220728-00399
- VernacularTitle:经皮胆道支架联合近程放疗治疗恶性梗阻性黄疸：一项多中心、回顾性、对照研究
- Author:
Xinhui HUANG
1
;
Songhui WU
;
Ping LI
;
Qiao KE
;
Xiadi WENG
;
Ling LI
;
Dexin LIU
;
Shaowu ZHUANG
;
Junhui SUN
;
Wuhua GUO
Author Information
1. 福建医科大学孟超肝胆医院介入科，福州 350025
- Keywords:
Malignant obstructive jaundice;
Brachytherapy;
Iodne-125 seed;
Stent;
Therapy
- From:
Chinese Journal of Hepatology
2022;30(7):702-709
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy, safety and prognostic factors of percutaneous biliary stent combined with iodine-125 seed chain brachytherapy (radiotherapy) in the treatment of malignant obstructive jaundice.Methods:Data of 107 cases with malignant obstructive jaundice treated with percutaneous biliary stent implantation from January 2017 to December 2020 were retrospectively analyzed. Among them, 58 cases received biliary stent combined with iodne-125 seed chain brachytherapy (study group), and 49 cases received biliary stent implantation (control group). The changes of bilirubin, stent patency time, complications, overall survival (OS) and prognostic factors were analyzed in both groups.Results:The incidence of complications in the study group and the control group were 17.2% and 18.3% respectively, and the difference was not statistically significant ( P=0.974). Serum total bilirubin levels were decreased significantly in both groups at one month after surgery ( P<0.001). Postoperative stent patency time was significantly better in the study group (10.0±1.6 months) (95% CI: 8.2～12.5) than that in the control group (5.2±0.4 months) (95% CI: 4.1～6.0, P<0.001). The median OS was longer in the study group (11.2±1.8 months) (95% CI: 9.2～12.8) than that in the control group (8.0±1.1 months) (95% CI: 8.0～12.8, P<0.001). Multivariate analysis result showed that stent combined with brachytherapy ( HR=0.08, 95% CI:0.04～0.15, P<0.001) and receiving further anti-tumor therapy after surgery ( HR=0.27, 95% CI:0.15~0.49, P<0.001) were independent risk factors affecting the patency of biliary stents. Preoperative percutaneous transhepatic biliary drainage ( HR=0.46, 95% CI:0.28～0.74, P=0.002), stent combined with brachytherapy ( HR=0.23, 95% CI:0.14～0.39, P<0.001) and receiving further anti-tumor therapy after surgery ( HR=0.37, 95% CI:0.22～0.61, P<0.001) were independent risk factors affecting OS. Conclusion:Percutaneous biliary stent combined with brachytherapy is safe and effective in the treatment of malignant obstructive jaundice, which can significantly prolong the patency time of biliary stent and the survival time of patients.
