经皮胆道支架植入术联合放疗治疗不可手术切除的肝门部胆管癌  

Percutaneous biliary stenting combined with radiotherapy for patients with unresectable hilar cholangiocarcinoma

作　　者：赵家锋[1] 邱宝安[2] 谭勇[1] 

机构地区：[1]广东省粤北人民医院肝胆外科,广东韶关512000 [2]解放军海军总医院肝胆外科,北京100048

出　　处：《肝胆胰外科杂志》2016年第6期469-472,480,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的描述肝门部胆管癌患者经皮胆道裸支架植入术的操作方法,评估操作的安全性;分析胆道裸支架植入术联合放疗是否延长不可手术切除的肝门部胆管癌患者支架通畅时间和生存时间。方法回顾性分析海军总医院和粤北人民医院肝胆外科2007年2月至2013年9月间不能手术切除肝门部胆管癌行经皮胆道裸支架植入术者38例临床资料,均在超声以及透视下行支架植入术。25例接受支架联合放疗(UMS+RT组),13例接受单纯支架治疗(UMS组)。收集患者支架植入术并发症发生情况;分析比较两组间支架通畅时间和生存时间的差异。结果经皮胆道裸支架植入术技术成功率为100%,胆道引流成功率为86.8%,早期并发症发生率为15.8%,手术相关病死率为2.6%。支架联合放疗组的中位支架通畅时间为326 d,单纯支架组中位支架通畅时间为196 d(P=0.022);支架联合放疗组生存时间明显长于单纯支架组(中位生存时间:367 d vs 267 d,P=0.025)。结论本研究结果显示经皮胆道裸支架植入术为不可手术切除肝门部胆管癌提供一种安全、有效的姑息治疗方法,支架联合放疗有助于延长支架通畅时间以及生存时间。Objective Patients with hilar cholangiocarcinoma are often unresectable at their initial diagnosis, and it is important to provide a definite palliative benefit for patients with unresectable hilar cholangiocarcinoma. The aim of the present study was to evaluate the safety of percutaneous biliary stenting and to analyze whether percutaneous biliary stenting combined with radiotherapy could prolong the stent patency and survival time of patients. Methods A total of 38 patients with unresectable hilar cholangiocarcinoma that received percutaneous biliary stenting in our institutions were retrospectively reviewed in the present study. Uncovered metallic stenting combined with radiotherapy （UMS＋RT group） was administered to 25 patients, and uncovered metallic stenting alone （UMS group） was administered to 13 patients. The records of early complications subsequent to percutaneous biliary stenting were collected, and the stent patency and survival times of patients were analyzed and compared between the two groups. Results The technical success rate of the procedure was 100% and the successful drainage rate was 86.8%. The overall early complication rate was 15.8% and the procedure-related mortality rate was 2.6%. The median stent patency was 326 d in UMS＋RT group and 196 d in UMS group （P=0.022）. The UMS＋RT demonstrated a longer survival time than the UMS group （median： 367 d vs 267 d, P=0.025）. Conclu-sion Percutaneous biliary stenting offers a safe and effective method for the palliative treatment of patients with unresectable hilar cholangiocarcinoma, and percutaneous biliary stenting combined with radiotherapy may prolong stent patency and survival time of patients.

关 键 词：肝门部胆管癌 不可手术切除 胆道裸支架 放疗 姑息治疗 

分 类 号：R735.8[医药卫生—肿瘤]