胆道支架联合高强度超声聚焦刀治疗胰腺癌合并梗阻性黄疸的临床观察  

Stent insertion combined with high-intensity focused ultrasound ablation for malignant obstructive jaundice caused by pancreatic carcinoma

作　　者：夏辉[1] 周程[1] 龚昭[1] 

机构地区：[1]武汉市第一医院肝胆外科,湖北武汉430022

出　　处：《局解手术学杂志》2017年第9期698-701,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨胆道支架联合高强度超声聚焦刀(HIFU)治疗胰腺癌导致的梗阻性黄疸的疗效与安全性。方法选择2013年1月至2017年2月80例胰腺癌合并梗阻性黄疸经胆道支架置入治疗的患者,根据支架置入术后是否进行HIFU治疗将患者分为联合治疗组(38例)与单纯支架组(42例),对比2组患者支架通畅时间及生存期。结果 2组患者黄疸均在胆道支架置入后缓解。7例患者在胆道支架置入术后并发胆管炎。80例患者随访(5.13±2.94)个月。15例患者发生支架再狭窄。联合治疗组患者中位支架通畅时间为179 d,中位生存期为209 d;单纯支架组患者中位支架通畅时间为119 d,中位生存期为145 d;2组患者比较差异有统计学意义(P<0.05)。根据单因素与多因素Cox回归分析结果,胆道支架术后进行HIFU治疗及肿瘤分期较早是延长患者生存期的因素(P<0.05)。结论胆道支架联合HIFU治疗胰腺癌导致的梗阻性黄疸安全有效;HIFU能够显著延长胆道支架通畅的时间以及生存期。Objective To investigate the safety and efficacy of stent insertion combined with high-intensity focused ultrasound（ HIFU ） ablation for malignant obstructive jaundice caused by pancreatic carcinoma. Methods From January 2013 to February 2017, a total of 80 patients with malignant obstructive jaundice caused by pancreatic carcinoma underwent biliary stent insertion in our center, who were divided into combined treatment（ stent insertion with HIFU ablation） group（ n = 38） and solitary stent insertion group（ n =42）. The stent patency time and survival time were compared between the two groups. Results Relief of jaundice were archived in all patients in both groups. Cholangitis was observed in 7 cases in both two groups. Reobstruction of stent was observed in 15 patients in both two groups. The median stent pateney time was 179 days in combined treatment group and 119 days in solitary stent insertion group（P 〈 0.01 ） ;the median survival time was 209 days in combined treatment group and 145 days in solitary stent insertion group,the differences were significant（P 〈 0.01 ）. Based on the univariate and multivariate Cox regression analyses, the predictors of prolonging survival included subsequent HIFU ablation after stent insertion and earlier tumor stage （ P 〈 0.05 ）. Conclusion Combined biliary stent insertion and HIFU ablation is a safe and effective method for malignant obstructive jaundice caused by pancreatic carcinoma, and seems to extend stent patency time and survival when compared with biliary stent only.

关 键 词：胆道支架 超声聚焦刀 胰腺癌 黄疸 

分 类 号：R735.95[医药卫生—肿瘤]