以往的几项研究表明，自膨胀金属支架（SEMS）和125I种植术的联合应用，可能延长支架通畅时间，获得恶性梗阻性黄疸（MOJ）患者的生存益处。然而，这些研究很少提及CT引导的肿瘤内125I种植术和支架内125I种子线插入联合应用，用于MOJ的处理。本研究旨在进一步评估SEMS结合125I放射治疗治疗不可切除MOJ的安全性和有效性。回顾性纳入了59例不可切除MOJ患者，时间为2018年3月至2021年6月。以支架通畅时间和总生存率为主要治疗结果，采用Kaplan-Meier生存分析计算支架通畅时间和总体生存率。分析了影响生存的临床和治疗因素。技术成功在所有患者中均得到实现。在种子组中，临床成功率为94％（32/34），对照组为92％（23/25），未发现显着差异（p =1.000）。125I放射治疗组的支架通畅时间中位数明显长于对照组（分别为289天和88天，p =0.001）。125I放射治疗组的总体生存率中位数明显优于对照组（分别为221天和78天，p =0.001）。在多元分析中，支架内125I放射治疗（p =0.004）是影响患者生存的重要有利预后因素。在支架通畅时间（p =0.268）和总生存率（p =0.483）方面，CT引导下的125I种植术和支架内125I种子线插入并没有显着差异。因此，SEMS结合125I放射治疗是治疗MOJ的安全有效方法，125I放射治疗可以帮助维持支架通畅时间并延长总生存率。CT引导下的125I种植术和支架内125I种子线插入对支架通畅时间和总生存率并没有显着差异。 ©2023。作者（们）。

Several previous studies demonstrated that the combination of self-expandable metallic stents (SEMS) and 125I seed implantation might prolong stent patency and obtain survival benefits for malignant obstructive jaundice (MOJ) patients. However, these studies rarely mentioned a comparison between CT-guided intratumoral 125I seed implantation and intraluminal 125I seed strand insertion combined with stenting for the management of MOJ. This study aimed to further evaluate the safety and efficacy of SEMS combined with 125I brachytherapy in the management of unresectable MOJ.Fifty-nine patients with unresectable MOJ were retrospectively included from March 2018 to June 2021. The main therapeutic outcomes were evaluated in terms of stent patency, and overall survival. Cumulative stent patency and overall survival rates were calculated by Kaplan-Meier survival analysis. Both clinical and treatment factors associated with survival were analyzed.Technical success was achieved in all patients. The clinical success rate was 94% (32/34) in the seeds group and 92% (23/25) in the control group, no significant difference was found (p =1.000). The median duration of stent patency was significantly longer in the 125I brachytherapy group compared with the control group (289 days vs. 88 days, respectively, p =0.001). The 125I brachytherapy group demonstrated a significantly better median overall survival rate than the control group (221 days vs. 78 days, respectively, p =0.001). In multivariate analysis, stents with 125I brachytherapy (p =0.004) was a significant favorable prognostic factor that affected patient survival. No significant difference was observed between CT-guided 125I seed implantation and 125I seed strand insertion in stent patency (p =0.268), and overall survival (p =0.483).SEMS combined with 125I brachytherapy is safe and effective for treating MOJ. 125I brachytherapy may help to maintain stent patency and prolong overall survival. There was no significant difference between CT-guided 125I seed implantation with SEMS and 125I seed strand insertion with SEMS in stent patency and overall survival.© 2023. The Author(s).