Experimental And Clinical Study Of Intraluminal ¹²⁵I Seeds On Treating The Malignant Obstructed Jaundice

Partâ… Experimental study of radiation damage of implanted radioactive ¹²⁵I seeds in swine bile ductObjective:To observe the extent of radiation injury of implanted ¹²⁵I seeds on normal bile duct and surrounding structure of the swine and explore the process of radiative injury and restoration of the bile duct with the dose of ¹²⁵I seeds,by introluminal brachytherapy ¹²⁵I seeds,the feasibility and safety of introluminal brachytherapy ¹²⁵I seeds.Methods:A total of 18 healthy experimental swinewere randomly assigned to study group(9) and control group(9).The two groups were then randomly devided into 3 subgroup:2 weeks,1 month and 2 months(three swine in each group).Five ¹²⁵I seeds(2.59×107Bq,0.7mGi) were encapsulated in soft plastic tube(length:35mm) and placed at the experimental swine's common bile duct and the same length of plastic tube encapsulated zero radioactive seeds were placed in control group.3 swine were after 2 weeks,1 month and 2 months of the placement procedure and the tissue of common bile duct were made specimen.Pathological and immunohistochemical changes of the two groups were observed and the difference was analyzed.The liver function of the two group in experimental animals at 2 weeks,1 month and 2 months were tested and the difference was analyzed statistically.Results:All the animals can be evaluated objectively concerning the effects.There were no severe complications such as bile duct perforation,hemorrhage.The liver function of between the two groups had no statistical significant difference(P＞0.05).Distinct pathological changes were noted in the subgroup of 2 weeks,there was markedly bile duct columnar epithelium exfoliating,the number of submucous intrinsic glandular was found to decrease significantly,with necrosis of partial glandular epithelium and an increase in fibroblasts,many submucous inflammatory cells were exudated and capillary vessel hyperaemia.While bile duct columnar epithelium in control group,there were a few submucous inflammatory cells exudated,with no fibrous tissue thickening.The difference in pathologic changes between two groups was significant.Bile duct epithelium in experimental group was seen with marked necrosis and exfoliation under electron microscopy,mitochondrial vacuolation degeneration was seen in some of the remaining epithelium cells.Ultrastructure injury of submucous in smooth muscle was seen;No ultrastructure injury of bile duct epithelium was found in control group.Immunohistochemistry Showed that difference of TNF-α(tumor necrosis factor),TGF-β(transforming growth factor-β),Bcl-2(B-cell lymphoma-2) between two groups had significance. Conclusion:(1)Intraluminal ¹²⁵I radiation caused radioactive injury to swine common bile duct epithelium and submucous intrinsic glandular to some extent,the extent of radiation injury according with the dose of radioactive and could be beared in clinical dose.(2) Common bile duct ¹²⁵I seeds implanted intraluminal radiation is a safe,efficient method with feasibility,it is promised to be used for further clinical study for treat malignant obstructive jaundice(MOJ)when ¹²⁵I seeds implanting in bile duct. Partâ…¡Clinical application of using intraluminal ¹²⁵I seeds combined with biliary stent implantation for malignant Obstructive JaundiceObjective To study the clinical effectiveness of biliary stent or biliary drainage tube implantation after PTCD combined with intraluminal brachytherapy by ¹²⁵I seeds in the treatment of malignant obstructive jaundice.Materials and Methods During the period from march 2008 to January 2009,7 patients with malignantly obstructive jaundice underwent biliary stent or biliary drainage tube implantation combined with intraluminal brachytherapy by ¹²⁵I seeds during PTCD.2 of them were diagnosed as gallbladder carcinoma,4 cases as Cholangiocarcinoma,1 case as hilar Hepatocellular carcinoma Patients ranged from(49～73)years old, mean age 63 years old,including 4 males and 3 females.10～15 ¹²⁵I seeds were implanted into bile duct via biliary extradrainage tube in each of 4 patients after PTCD.20～25 ¹²⁵I seeds were implanted in each of 3 patients while undergoing biliary stent implantation during PTCD.Liver function, imaging findings,adverse reaction(ADR) and survival time were followed after operation.Results All patients completed this operation successfully,with no severe complications.Liver function at 2ed week, 1st,2ed,4th,6th month after ¹²⁵I seeds implanting,showed serum ALT,AST,TB,CB and WBC has no dramatic increasing.Abdominal CT scan 1st month,3rd month,6th month after operation showed that intra bile duct ¹²⁵I seeds were well in place.Lesion surrounding the seeds was seen thinning with mass shrinking in 4 patients,cholangiography showed good stent patency for 6 patients at 3rd month.One patient who endured recurrent jaundice and got a stricture in bile-stent at 6th month,to be dilated by a sacculus.Except bile exosmosis along the drainage tube in one case,no other complications were seen.In the follow-up study,one case was dead in the 3rd month and another in the 8th month.The longest case was follow him 14th month and then lost contact.Conclusion biliary stent or biliary drainage tube implantation after PTCD combined with intraluminal brachytherapy by ¹²⁵I seeds in the treatment of malignant obstructive jaundice is a method with certain and prolonged effectiveness, and is hoped to be deeped studied in clinic.