胆道金属支架联合腔内射频消融治疗胆管恶性梗阻的研究  

Study of biliary metal stent combined with intracavitary radiofrequency ablation for malignant bile duct obstruction

作　　者：周鸿鲲 王晓光 殷新光 张杰 赵凤庆 姜达伟 谢琦 钱能 ZHOU Hongkun;WANG Xiaoguang;YIN Xinguang(The First Hospital of Jiaxing,Zhejiang 314000,China.)

机构地区：[1]浙江省嘉兴市第一医院,嘉兴314001 [2]浙江省嘉兴市第二医院

出　　处：《浙江创伤外科》2020年第2期199-201,共3页Zhejiang Journal of Traumatic Surgery

基　　金：浙江省医药卫生科技计划项目(2019KY219);嘉兴市科技计划项目(2016AY23034)。

摘　　要：目的分析胆道金属支架联合腔内射频消融治疗胆管恶性梗阻的疗效及安全性。方法前瞻性纳入自2016年1月1日至2017年12月31日因胆管恶性梗阻在本院住院治疗的患者48例,分为试验组(金属裸支架联合腔内射频消融组)18例和对照组(金属覆膜支架组)30例,比较两组间疗效和安全性。结果所有纳入试验的患者均成功实施预定手术,术后7天两组胆红素水平均较术前明显下降,差异具有统计学意义(P<0.05)。术后7天试验组和对照组总胆红素分别为(83.50±52.13)μmol/L和(82.50±47.38)μmol/L,两组间差异水平无明显统计学意义(P>0.05)。术后试验组有2人CA19-9较术前下降明显,对照组有1人胆红素较前有明显下降,两组间差异无统计学意义(P>0.05)。试验组总体晚于对照组发生术后再次狭窄,分别为(8.00±2.63)月和(6.22±2.74)月,差异有统计学意义(P<0.05)。试验组术后生存期明显优于对照组,分别为(10.63±1.78)月和(8.70±2.44)月,差异具有统计学意义(P<0.05)。试验组共有5例患者出现可疑操作相关并发症,对照组共有5例患者出现可疑操作相关并发症,两组并发症发生情况差异无统计学意义(P>0.05)。结论对于胆道恶性肿瘤所致梗阻性黄疸患者,ERCP引导下腔内射频消融联合支架置入可显著改善患者黄疸情况,延长患者生存时间,同时安全性和单纯支架置入术相当,可进一步临床推广应用。Objective To analyze the efficacy and safety of biliary metal stent combined with intracavitary radiofrequency ablation for malignant biliary obstruction.Methods 48 patients with malignant biliary obstruction from January 1,2016 to December 31,2017were prospectively included in this study.18 patients were enrolled into the experimental group(metal bare stent combined with intracavitary radiofrequency ablation),and30 cases were in the control group(metal stent stent group).The efficacy and safety were compared between the two groups.Results All the patients were received the scheduled operationsuccessfully.7 days after operation,the total bilirubin in the two groups decreased significantly than before the operation,and the difference was statistically significant(P<0.05).The total bilirubin in the experimental group and the control group was(83.50±52.13)μmol/L and(82.50±47.38)μmol/L respectivelyat 7 days postoperative,which hadno significant difference(P>0.05).2patients in the experimental group and 1 patients in the control grouphad a significant decrease in CA19-9,and therewas no statistically significant difference(P>0.05).Thepostoperative restenosisin the experimental group waslonger than that in the control group,which were(8.00±2.63)months and(6.22±2.74)months respectively,with statistically significant(P<0.05).The survival time of the experimental group was significantly better than that of the control group,which were(10.63±1.78)months and(8.70±2.44)months respectively(P<0.05).Both groups had 5 patients who had suspicious operation-related complications.Conclusion For patients with obstructive jaundice caused by biliary malignant tumors,ERCP guided intracavity radiofrequency ablation combined with stent placement can significantly improve the patients'jaundice and prolong the survival time.At the same time,the safety is equivalent to that of simple stent implantation,and it can be further clinically promoted application.

关 键 词：胆管恶性梗阻 支架 射频消融 内镜下逆行胰胆管造影 

分 类 号：R657.4[医药卫生—外科学]