内镜下腔内射频消融治疗晚期胆管癌的临床研究  

Clinical effects of endoscopic radiofrequency ablation for patients with advanced cholangiocarcinoma

作　　者：曹良启[1] 李越[1] 何南[1] 魏章均 张大伟[1] 梁惠宏[1] 邵子力[1] 

机构地区：[1]广州医科大学附属第二医院肝胆外科,广州510260

出　　处：《中华消化内镜杂志》2017年第11期783-786,共4页Chinese Journal of Digestive Endoscopy

基　　金：广东省科技计划项目（2014A020212326）;广东省自然科学基金（2015A030313466）

摘　　要：目的探讨内镜下腔内射频消融治疗晚期胆管癌的疗效及安全性。方法回顾性分析2011年10月至2014年10月内镜治疗的45例晚期不可手术胆管癌患者的临床资料，比较消融组（23例）和非消融组（22例）术后并发症发生情况，术后CAl9—9和总胆红素（TBIL）水平，支架通畅情况和生存时间。结果45例患者均顺利完成治疗，术后未出现穿孔、出血和胆漏情况；术后发热消融组2例，非消融组3例，一过性胰腺炎消融组5例，非消融组4例，予以对症处理后症状均消失。术后消融组疼痛者5例（21．7％），非消融组12例（54．5％），消融组疼痛发生率低于非消融组（疋。=5．148，P=0．023）。术后7d消融组和非消融组血浆CAl9—9分别为（960．5＋362．7）U／mL和（979．3＋378．1）U／mL，TBIL分别为（95．25~28．36）Ixmol／L和（98．75＋20．76）Ixmol／L，较术前均显著降低（P〈0．05），而术后两组血浆CAl9—9和TBIL水平相比差异无统计学意义（P〉0．05）。术后9个月消融组金属支架通畅率60．O％（6／10），高于非消融组的10．0％（1／10）（∥=5．495，P=0．019）。Kaplan—Meier生存分析显示消融组中位生存时间271．0d（95％CI：168．4—373．4d），非消融组为245．0d（95％CI：200．3～289．7d），两组生存时间差异无统计学意义（爿。1．380，P=0．258）。结论内镜下腔内射频消融可以缓解癌性疼痛，延长支架通畅时间，提高患者生活质量，疗效肯定，值得临床推广。Objective To investigate the efficacy and safety of endoscopic radiofrequency ablation on patients with advanced stage unresectable cholangiocarcinoma. Methods Clinical data of 45 cases with unresectable cholangiocarcinoma who underwent endoscopic retrograde cholangiopancreatography from October 2011 to October 2014 were collected. The patients were divided into two groups： the group A included 23 cases undergoing radiofrequency ablation, and the group B included 22 cases without ablation. The occurrence of comphcations, the postoperative levels of CA19-9 and total bilirubin （TBIL） in blood plasma, the patency of stents, and survival period were compared between the two groups. Results All of the 45 patients completed treatment, and no perforation, bleeding and bile leakage occurred. In the group A, 2 patients got fever and 5 patients got pancreatitis after operation, and the number in the group B was 3 and 4, respectively. Their symptoms disappeared after suitable treatment. The postoperative pain rate in group A （21.7%, 5/23） was significantly lower than that of group B （54. 5%, 12/22, X2 =5. 148, P=0. 023）. At Th day of post-operation, the levels of CA19-9 in the two groups were 960. 5±362. 7 U/mL and 979. 3±378. 1 U/mL, respectively, and the levels of TBIL were 95.25±28. 36μmol/L and 98.75±20. 76μmoL/L, respectively, which were not significantly different between the two groups（ P〉0.05）, but were significantly decreased compared with the levels of pre-operation （P〈O. 05 ）. The patency of self-expandable metal stent in group A （60. 0%, 6/10） was significantly higher than that of group B （ 10. 0%, 1/10, X： = 5.495, P=0. 019） 9 months after operation. Kaplan-Meier analysis showed that the median survival time in the two groups had no statistical difference [ 271.0 days （ 95% CI： 168.4-373.4days） VS 245.0 days （ 95% CI： 200. 3-289. 7 days）, X2 = 1. 380, P =0. 258 ]. Conclusion For the patients with advanced unresectable cholangiocarcinoma, endoscopic radiofreq

关 键 词：胆道肿瘤 胰胆管造影术 内窥镜逆行 导管消融术 

分 类 号：R735.8[医药卫生—肿瘤]