内镜射频消融联合支架置入技术治疗晚期胆道恶性梗阻8例临床分析  

Clinical analysis of 8 cases plastic stenting with radiofrequency ablation for treatment of unresectable malignant biliary obstruction

作　　者：王成[1] 邵峰[1] 黄强[1] 胡元国[1] 邱陆军[1] 查恕云[1] 

机构地区：[1]安徽省立医院普外科,合肥230001

出　　处：《肝胆外科杂志》2015年第2期95-97,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨经内镜射频消融联合支架置入技术治疗晚期胆道恶性梗阻的安全性及疗效。方法我院于2013.11-2014.6期间,共对8例无法手术切除的胆道恶性梗阻患者实施经内镜射频消融联合支架置入技术进行治疗,在胆管插管成功后,循导丝导入专用双极射频电极,于肿瘤部位进行射频消融,每次射频消融功率为8~10瓦,消融时间90~120秒,然后留置胆道支架,观察术后恢复情况并密切随访。结果所有患者均成功完成射频消融治疗并留置胆道塑料支架（其中1例同期放置胰管支架）。1例出现继发性胆囊炎,急诊行开腹胆囊切除术。2例出现高淀粉酶血症,经短期保守治疗控制。黄疸有效缓解率为100%（8/8）;平均随访6.5个月（4~9个月）,有2例患者在治疗后4.5个月左右再次出现黄疸,同时合并十二指肠降部梗阻,内镜无法通过,行剖腹胆肠、胃肠内引流术;其余患者支架均保持通畅。结论对于无法手术切除的胆道恶性梗阻患者,采用经内镜射频消融联合支架置入治疗是安全可行的,且近期疗效满意。Objective The objective of this study was to analyze safety and efficacy of plastic stenting with radiofrequency ab- lation for treatment of unresectable malignant biliary obstruction. Methods 8 patients with unresectable malignant biliary obstruction who underwent RFA with plastic stent between November 2013, and Jane 2014 were retrospectively analyzed. After biliary cannulation, a wire at the level of the biliary stricture and ablation using ERBE generator set at 8 - l0 watts for a time period of 90 - 120 s was con- ducted. The plastic stents were placed after RFA. All patients were followed up. Results All patients were performed plastic stenting with radiofrequency ablation successfully. One patient was diagnosed cholecystitis after the procedure, who were underwent laparoscop- ic cholecysteetomy. Hyperamylasemia were observed in two cases, which were treated conservatively. Jaundice was uccessfully reduced in 8 patients （ 100% ）. The follow - up was range from 4 to 9 months （ Median 6. 5 month）. Jaundice recurred in two patients after 4. 5 month, which could not treated by endoscopic method due obstruction of duodenum, were treated surgically. The stents were patency in other patients. Conclusion Plastic stenting with radiofrequency ablation for treatment of unresectable malignant biliary obstruction is safety and the short -term result is satisfied.

关 键 词：内镜逆行胰胆管造影术 晚期胆道恶性梗阻 射频消融 

分 类 号：R657.9[医药卫生—外科学]