胆管内双极射频消融联合支架植入术治疗恶性胆管梗阻的研究  

Clinical application of endobiliary bipolar radiofrequency ablation combined with stenting in treatment for malignant biliary obstruction

作　　者：余辉[1] 席玮[1] 武贝[1] 陆游[1] 陆逸[1] 陈世晞[1] 陈骏[1] 

机构地区：[1]江苏省肿瘤医院(江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院)介入科,江苏南京210009

出　　处：《中国肿瘤外科杂志》2017年第2期81-86,共6页Chinese Journal of Surgical Oncology

基　　金：江苏省"六大人才高峰"第十一批高层次人才培养入选项目(No.2014-WSW-015)

摘　　要：目的探讨经皮肝穿刺胆管腔内双极射频消融联合支架植入术治疗恶性胆管梗阻的可行性、安全性及临床疗效。方法分析江苏省肿瘤医院2012年3月至2016年1月27例经皮肝穿刺治疗恶性胆管梗阻患者临床资料,其中9例行经皮肝穿刺胆管内射频消融联合内支架置入术(胆管射频消融组),18例行单纯内支架置入术(单纯胆管支架组)。观察手术安全性、并发症及近期疗效情况。采用Kaplan-Meier方法比较两组患者的支架通畅率及患者生存时间。结果 27例患者均顺利完成手术。胆管射频消融组手术操作时间平均58.6 min(42.0~70.0 min),较单纯胆管支架组平均手术操作时间45.0 min(35.0~60.0 min)有所增加(P=0.003)。两组患者术中均无并发症发生。术后两组患者的胆管感染、腹痛、恶心呕吐等并发症发生率比较,差异无统计学意义。两组患者术后血清胆红素、转氨酶均明显改善。治疗后3个月胆管射频消融组胆管支架通畅率为100%(8/8),单纯胆管支架组为50%(7/14),P=0.022;6个月时分别为100%(6/6)和0,两组比较,P=0.036。胆管支架中位通畅时间,胆管射频消融组为189 d(Q1,92 d;Q3,279 d),单纯胆管支架组为87 d(Q1,82 d;Q3,161 d),两组比较,P=0.001。在治疗后6个月,胆管射频消融组生存率为66.7%(6/9),单纯胆管支架组为11.1%(2/18),两组比较,P=0.006。9个月生存率分别为33.3%(3/9)和0,两组比较,P=0.029。患者中位生存时间胆管射频消融组189 d(Q1,100 d;Q3,279 d),单纯胆管支架组118 d(Q1,96 d;Q3,171 d),两组比较,P=0.028。结论经皮肝穿刺胆管腔内射频消融联合支架植入治疗恶性胆管梗阻安全可行,临床疗效优于单纯支架置入术,可延长支架的通畅期和患者的生存期。Objective To investigate the feasibility, safety and clinical efficacy of percutaneous transhepatic endobiliary bipolar radiofrequency ablation coupled with biliary metallic stenting for treating malignant biliary obstruction. Methods The clinical data of 27 patients with malignant biliary obstruction who underwent percutaneous transhepatic interventional therapy in Jiangsu Cancer hospital from March 2012 to January 2016 were analyzed retrospectively. Percutaneous endobiliary radiofrequency combined with metal biliary stenting were performed in nine patients（ the RFA group）, while the other eighteen patients received only metal biliary stenting （the stent group）. The safety, procedure-related complications, and short-term clinical efficacy were investigated. Stent patency and patient survival time were compared between the two groups by Kaplan-Meier methods. Results Percutaneous transhepatic treatment was completed in all 27 patients. The average duration of operation was significantly longer in the RFA group（58. 6 min, 42 - 70 min） than that in the stent group （45.0 min, 35 - 60 min, P =0. 003）. No immediate procedural complications occurred in patients of both groups. The incidence of postoperative complications including biliary tract infection, abdominal pain and vomiting had no significant differences. The bilirubin and transaminase were significantly improved after treatment. The patency rate for stents at 3 months after treatment was 100% （8/8） in the RFA Group, 50% （7/14） in the stent group（P =0. 022）, and which at 6 months after treatment was 100% （6/6） in the RFA group, 0% （0/2） in the stent group（P =0. 036）. The median stent patency was 189 days（quartile 1, 92 days; quartile 3, 279 days） in the RFA Group, which was significantly longer than 87 days（quartile 1, 82 days; quartile 3, 161 days） in the stent group（P = 0. 001 ）. The survival rate at 6 months after treatment was 66. 7% （6/9） in the RFA group, 11.1% （2/18） in the stent group（P =0. 0

关 键 词：癌 导管消融术 支架 恶性胆管梗阻 双极射频 

分 类 号：R730.5[医药卫生—肿瘤]