内镜辅助双极射频消融在胆管恶性狭窄金属支架堵塞后再通中的应用  

Endobiliary intraductal radiofrequency ablation to reopen occluded biliary metal stents in malignant biliary obstruction

作　　者：姜中华 张秀华[2] 王飞[2] 李全鹏[2] 蒋国斌[2] 缪林[3] 范志宁 

机构地区：[1]盐城市第一人民医院消化内镜中心,224406 [2]南京医科大学第二附属医院消化内镜中心,224406 [3]南京医科大学第二附属医院消化医学中心,224406 [4]南京医科大学第一附属医院消化内镜中心,224406

出　　处：《中华肝胆外科杂志》2015年第10期678-681,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：教育部高等学校博士学科点专项科研基金（20123234110003）;江苏省自然科学基金（BK2011859）;江苏省医学领军人才与创新团队基金（LJ201127）

摘　　要：目的研究恶性胆管狭窄行自膨式金属支架置入患者内镜辅助射频消融（RFA）再通堵塞支架的安全性和可行性。方法前瞻性纳入恶性胆管狭窄置入金属支架后支架堵塞的11例患者。内镜逆行胰胆管造影（ERCP）插管成功后，循导丝支架内导入双极射频电极对狭窄部行RFA，再用球囊反复清扫坏死组织并留置鼻胆管。观察术后疗效、安全性、并发症。结果所有患者均成功实施RFA完成支架再通。患者中位消融后支架内径6（4～10）mm，较消融前2（0-5）mm明显增宽（P〈0．05）；术后平均总胆红素浓度（39．4±8．7）μmol／L，较术前（130．1±38．2）μmol／L明显减低（P〈0．05）；3例出现发热症状，均经对症处理好转，无射频消融相关死亡、出血，胆管穿孔、胆瘘并发症。中位随访时间187（75-304）d，中位支架通畅时间135（75～203）d，中位生存时间278（75-304）d。共有3例患者死亡，8例存活，4例在随访结束或死亡时支架仍通畅。RFA后7例支架再次阻塞时间分别为113、124、154、203、96、135、112d。结论RFA再通因恶性肿瘤增生堵塞的金属支架安全、有效，但近远期疗效有待进一步研究。Objective To study the safety and feasibility of endobiliary intraductal radiofrequency ablation （RFA） to reopen occluded self-expandable metal stents in patients with malignant biliary obstruc- tion. Methods 11 patients with malignant biliary obstruction and blocked metal stents were prospectively studied. During ERCP, after biliary cannulation, the blocked metal stents underwent RFA using a bipolar radiofrequency probe which was introduced into the stenotic bile duct via a guide wire. This was followed by a balloon to repeatedly remove debris and then endoscopic nasobiliary drainage. The patients were closely ob- served and followed up. Results RFA was successfully carried out in all the patients and patencies were a- chieved when compared with pre-RFA. The median post-RFA luminal diameter of the strictures showed sig- nificant improvement： 6 （4 ~ 10） mm versus 2 （0 -5 ） mm, and the mean post-RFA total bilirubin level decreased sharply： （39.4 ± 8.7 ） μmol/L versus （130. 1 ± 38.2 ） μmol/L. Following this intervention, 3 patients developed fever, which were controlled with conservative therapy. There was no mortality, haemor- rhage, bile duct perforation or bile leak. Of the 11 patients, 3 were dead and 6 were alive at a median fol- low-up of 187 （75 -304） days. The median stent patency was 135 （75 -203 ） days and the median survival was 278 （75 -304 ） days. Four patients had their stents patent at the time of the last follow-up or death. Seven patients bad their stents blocked on 113, 124, 154, 203, 96, 135 and 112 days post-procedure. Conduslons Endobiliary intraductal RFA is technically feasible and safe to reopen occluded metal stents in malignant biliary obstruction. This efficacy needs to be confirmed by future randomized studies.

关 键 词：胰胆管逆行造影 射频消融 恶性胆道梗阻 支架堵塞 

分 类 号：R735.1[医药卫生—肿瘤]