经内镜腔内射频消融术联合支架治疗恶性胆管梗阻的疗效评价  

The safety and efficacy of radiofrequency ablation( RFA) combined with stent implantation for malignant biliary obstruction via ERCP

作　　者：周玉保[1] 张道权[1] 郑成 詹翔[1] 胡红娜[1] 郝睿[1] 牛森森 金树[1] ZHOU Yu-bao;ZHANG Dao-quan;ZHENG Cheng(The Second Hodpital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院消化内镜科,合肥230601

出　　处：《肝胆外科杂志》2018年第4期265-268,共4页Journal of Hepatobiliary Surgery

基　　金：安徽医科大学校基金(编号2015Xkj124)

摘　　要：目的探讨经ERCP途径胆管腔内射频消融术(RFA)联合支架置入治疗恶性胆管梗阻的安全性、有效性。方法回顾分析2013年10月至2017年05月安徽医科大学第二附属医院经ERCP射频消融术(RFA)联合支架置入治疗恶性胆管梗阻的29例患者临床资料。观察所有患者术中血压及血氧变化,分析术后6小时、次日晨测血淀粉酶、血常规,术后3日、30日监测肝功能,评定黄疸消退疗效,以及早期并发症及操作相关死亡率,30天支架通畅率、生存期等资料。结果 29例患者成功进行35例次RFA治疗,胆道引流成功率为35/35(100%),RFA术后16例次放置塑料支架,其中8例肝门部Bismuth分型Ⅲ型及以上患者,放置2根ERBD,9例术后放置SEMS,10例术后放置ENBD(4例为胆管放置SEMS再堵塞患者行RFA疏通治疗)。6例次术后2周内出现胆管感染,均为放置ERBD患者,5例保守治疗缓解,1例重新更换支架,术后胆管感染率为17. 1%(6/35);高淀粉酶血症5例,发生率14. 3%(5/35); 1例胆管出血,术后出血率为2. 8%(1/35);无穿孔、胰腺炎患者,无操作相关死亡发生;术后30天支架通畅率97. 1%(34/35),随访6个月生存率88. 5%(23/26),一年生存率52. 6%(10/19),较同期非RFA组恶性胆管梗阻患者生存期延长。结论经ERCP途径胆管腔内射频消融术联合支架治疗恶性胆管梗阻安全性高,操作可行,初期临床疗效确切。Objective To evaluate the safety and efficacy of radiofrequency ablation （RFA） combined with stent implantation for malignant biliary obstruction via ERCP. Methods Retrospective analyzed the clinical data of 29 patients with malignant biliary obstruction treated by radiofrequeney ablation （RFA） combined with stent implantation in the Second Hospital of Anhui Medical University from October 2013 to 2017, 05. The changes of blood pressure and blood oxygen in all patients were observed,The blood amylase and blood routine value were measured at 6 hours and the following morning after ERCP. Results 29 patients were treated with RFA for 35 times, and the success rate of biliary drainage was 35/35 （ 100% ）, Plastic stent was placed 16 times after RFA, of which 8 patients with type BismuthIII or more were placed with 2 ERBD ;9 cases were placed SEMS （self-expandable metallic stems, SEMS）, 10 cases were placed ENBD;Biliary infection occurred in 6 cases within 2 weeks after operation, and the infection rate was 17.1% （6/ 35） ;The incidence of high level blood amylase was 14. 3% （5/35） ;1 cases of bile duct bleeding, the bleeding rate was 2. 8% （ 1/ 35 ） ;No perforation and pancreatitis, No operation related death occurred （ 〈 30D） ; The patency rate of stent was 97.1% （34/35） 30 days after operation, Follow up for 6 months, the survival rate was 88. 5% （23/26）, and the 1-year survival rate was 52. 6% （ 10/ 19） ,The survival time was longer in patients with malignant biliary obstruction than in the non RFA group. Conclusion Radiofrequency ablation combined with biliary stent for the treatment of malignant biliary obstruction via ERCP pathway is safe and feasible, the initial clinical efficacy is accurate.

关 键 词：胰胆管造影术 内窥镜逆行 胆道肿瘤 射频消融 支架 

分 类 号：R735.8[医药卫生—肿瘤]