经内镜射频消融联合支架治疗不可切除肝外胆管癌的疗效评价  

Efficacy and safety of endobiliary radiofrequency ablation with stent placement in treatment of non-resectable extrahepatic cholangiocarcinoma

作　　者：杨建锋[1] 周海斌 周益峰[1] 金杭斌[1] 楼奇峰[1] 吕文[1] 张啸[1] 张筱凤[1] 

机构地区：[1]杭州市第一人民医院消化科,310006 [2]杭州市老年病医院

出　　处：《中华消化内镜杂志》2017年第6期418-422,共5页Chinese Journal of Digestive Endoscopy

基　　金：浙江省科技计划项目（2015C33251）;浙江省医药卫生科技计划项目（2016RCB015）;杭州市卫生科技计划（2014201）

摘　　要：目的探讨经内镜射频消融（RFA）联合支架置入治疗不可切除肝外胆管癌（EHCC）的临床疗效及安全性。方法纳入2013年10月至2015年1月杭州市第一人民医院就诊的不可切除EHCC患者，采用前瞻性随机单盲法队列研究，按随机数字表随机分为行RFA联合胆道支架置入术（RFA＋支架组）及单纯胆道支架（支架组）治疗，对比2组患者黄疸消退时间、支架通畅期、总体生存期和术后并发症发生率。结果共纳入59例患者，其中28例为RFA＋支架组，31例为支架组。术前2组血清总胆红素差异无统计学意义，RFA＋支架组术后黄疸消退时间明显短于支架组[17．9d（7-22d）比29．9d（10-55d），P=0．03]。RFA＋支架组平均支架通畅时间明显长于支架组（8．9个月比4．5个月，P=0．02）。RFA＋支架组患者平均总体生存期明显长于支架组[13．3个月（6．2-16．5个月）比8．6个月（4．5-11．7个月），P=0．000]。2组间术后近期并发症发生率差异无统计学意义（P=0．727）。结论RFA联合支架治疗不可切除EHCC，能明显缩短患者的黄疸消退时间，延长支架通畅期和生存期，可作为EHCC安全有效的姑息治疗方法。Objective To study the efficacy and safety of endobiliary radiofrequency ablation （RFA） with stent placement in treatment of unresectable extrahepatic cholangiocarcinoma （EHCC）. Methods The patients with unresectable EHCC in Hangzhou First People＇s Hospital between October 2013 and January 2015 were enrolled in a prospective, randomized, single-blind cohort study, and were assigned randomly into two groups： RFA＋stent group and stent-only group. The jaundice fade time, stent patency period, overall survival rate, and postoperative adverse events were analyzed between two groups. Results Among 59 patients with non-resectable EHCC, 28 were divided into RFA ＋ stent group, and 31 were in stent-only group. There was no statistical difference in preoperative serum total bilirubin between the two groups. Mean serum bilirubin decrease time was significantly lower in the RFA＋stent group than that in the stent-only group[ 17.9 d（7-22 d） VS 29. 9 d（ 10-55 d） ,P--0. 03]. The biliary patency period in RFA＋ stent group was significantly longer than that of stent-only group （ 8.9 months VS 4. 5 months, P = 0. 02）. The mean survival time in RFA＋stent group was significantly longer than that of stent-only group[ 13.3 months（ 6. 2-16. 5 months ） VS 8.6 months （ 4. 5-11.7 months）, P = 0. 000）. Incidence of postoperative adverse events showed no statistical difference between the two groups（P=0. 727）. Conclusion RFA with stent placement is effective and safe as a palliative measure in the treatment of non-resectable EHCC, and it can significantly shorten the jaundice fade time, prolong the biliary patency period and overall survival, while without increase of the incidence of adverse events.

关 键 词：内镜治疗 支架 射频消融术 肝外胆管癌 生存期 

分 类 号：R735.8[医药卫生—肿瘤]