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[目的]探讨调强适形放射治疗技术(IMRT)治疗恶性胆道梗阻的效果和价值。[方法]对21例消化道恶性肿瘤发生肝门或腹腔动脉周围淋巴结转移引起胆道梗阻患者(KPS≥70分),采用调强适形放射技术治疗。总处方剂量45.0～50.0Gy。[结果]21例患者中19例轻或中度梗阻性黄疸患者完成全程的放射治疗,计划靶区(PTV)的中位剂量为46.1Gy,90%的等剂量曲线可以覆盖99%以上的肿瘤靶区(GTV)。19例患者放疗前平均总胆红素(STB)218.3±137.6μmol/L,放疗结束后平均血清总胆红素89.4±67.1μmol/L,其中显效12例(63.15%),改善7例(36.84%),腹痛者均缓解。4例患者出现Ⅰ度骨髓抑制,1例出现Ⅱ度骨髓抑制,5例患者出现Ⅰ级恶心、呕吐。3个月后复查CT,完全缓解率31.57%(6/19),部分缓解率68.42%(13/19),有效率100%。随访期间1例患者死于心、肺意外,1年生存率94.73%。[结论]IMRT治疗消化道肿瘤引起的恶性胆道梗阻可获得较理想的剂量分布,临床疗效满意,是一种积极有效的治疗方法。
[Objective] To investigate the effect and value of intensity modulated radiotherapy (IMRT) on malignant biliary obstruction. [Method] Twenty-one patients with gastrointestinal tract malignant tumor with hepatic or peritoneal lymph node metastasis caused by biliary obstruction (KPS≥70) were treated with intensity-modulated conformal radiotherapy. The total prescription dose 45.0 ~ 50.0Gy. [Result] The complete radiotherapy was completed in 19 patients with mild or moderate obstructive jaundice in 21 patients. The median dose of planned target area (PTV) was 46.1 Gy. 90% of the isodose curves could cover more than 99% of the tumors Target Area (GTV). The mean total bilirubin (STB) was 218.3 ± 137.6μmol / L before radiotherapy in 19 patients, mean serum bilirubin was 89.4 ± 67.1μmol / L after radiotherapy, of which 12 (63.15%) were markedly improved and 7 (36.84) %), Abdominal pain were relieved. Four patients had grade I myelosuppression, one case had grade II myelosuppression, and five patients presented with grade I nausea and vomiting. Three months after the review of CT, the complete remission rate was 31.57% (6/19), the partial remission rate was 68.42% (13/19), with an effective rate of 100%. One patient died of heart and lung accident during follow-up, and the one-year survival rate was 94.73%. [Conclusion] IMRT is an effective and effective treatment method for malignant biliary obstruction caused by digestive tract tumors, which can achieve ideal dose distribution and satisfactory clinical curative effect.