经PTCD与ENBD置管冷却技术预防肝癌微波消融术胆管热损伤的效果对比  

Effects comparison of PTCD and ENBD for intraductal cooling on the prevention of bile duct thermal injury during microwave ablation for hepatocellular carcinoma

作　　者：卢建利 贺伟 刘进衡 LU Jianli;HE Wei;LIU Jinheng(Department of Hepatobiliary and Pancreatic Surgery,Chengdu 363 Hospital of Southwest Medical University,Chengdu,Sichuan 610041,China;Department of Hepatobiliary and Pancreatic Surgery,Chengdu Second People’s Hospital,Chengdu,Sichuan 610000,China)

机构地区：[1]西南医科大学附属成都三六三医院肝胆胰外科,四川成都610041 [2]成都市第二人民医院肝胆胰外科,四川成都610000

出　　处：《肝胆胰外科杂志》2023年第11期668-673,共6页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的观察经皮肝胆管穿刺引流(PTCD)与经内镜鼻胆管引流(ENBD)置管冷却技术对肝癌微波消融术疗效影响及对胆管热损伤预防效果。方法回顾性分析西南医科大学附属成都三六三医院和成都市第二人民医院2017年9月至2020年9月收治的87例肝门部肝癌行微波消融术患者临床资料,根据术中置管引流技术不同,分为PTCD组(41例)和ENBD组(46例),PTCD组经皮肝穿刺留置PTCD管,然后在PTCD管内持续灌注冷却液下行微波消融;ENBD组经内镜胰胆管造影下留置ENBD管,然后在ENBD管内持续灌注冷却液行微波消融。结果ENBD组与PTCD组微波消融时间比较差异无统计学意义(P>0.05)。术后1 d,两组TBIL、ALT水平均较术前升高(P<0.05),两组间比较差异无统计学意义(P>0.05);ENBD组AMS水平较术前的升高[(145.89±46.47)U/L vs(77.91±15.64)U/L,P<0.05],且显著高于PTCD组的[(82.35±15.84)U/L](P<0.05)。ENBD组术后急性胰腺炎发生率[13.04%(6/46)vs 0]、并发症总发生率[30.43%(13/46)vs 2.44%(1/41)]显著高于PTCD组(P<0.05)。术后1个月,两组血清AFP、CEA、CA199水平均较术前下降(P<0.05),两组间比较差异无统计学意义(P>0.05)。随访2年,PTCD组与ENBD组总复发率[17.07%(7/41)vs 13.04%(6/46)],病死率[4.88%(2/41)vs 6.52%(3/46)]差异均无统计学意义(P>0.05)。结论经PTCD与ENBD置管冷却技术用于肝癌微波消融术治疗,对患者肿瘤标志物改善、复发率及死亡率影响相当,但PTCD置管预防胆管热损伤效果更好,可有效降低术后并发症风险。Objective To observe the efficacy of the intraductal cooling technique by percutaneous transhepatic cholangial drainage(PTCD)and endoscopic nasobiliary drainage(ENBD)during microwave ablation for hepatocellular carcinoma(HCC)and analyze preventive effect on bile duct thermal injury.Methods The clinical data of 87 patients with hilar hepatocellular carcinoma who underwent microwave ablation in Chengdu 363 Hospital of Southwest Medical University and Chengdu Second People’s Hospital between Sep.2017 and Sep.2020 were retrospectively analyzed.According to the intraoperative catheter drainage techniques,the patients were divided into the PTCD group(41 cases)and the ENBD group(46 cases).In the PTCD group,the PTCD tube was retained by percutaneous liver puncture,and then the microwave ablation was performed with the continuous perfusion of coolant by the PTCD tube.In the ENBD group,the ENBD tube was retained under endoscopic cholangiopancreatography,and then the coolant was continuously perfused into the ENBD tube during the microwave ablation.Results There was no statistically significance in microwave ablation time between the PTCD group and the ENBD group(P>0.05).One day after surgery,the levels of TBIL and ALT in the two groups were enhanced compared with those before surgery(P<0.05),but there were no statistical differences in TBIL and ALT levels between the two groups(P>0.05).The level of AMS in the ENBD group was increased compared with that before surgery[(145.89±46.47)U/L vs(77.91±15.64)U/L,P<0.05],and was significantly higher than that in the PTCD group(82.35±15.84)U/L(P<0.05).The incidence rate of postoperative acute pancreatitis[13.04%(6/46)vs 0]and total incidence rate of complications[30.43%(13/46)vs 2.44%(1/41)]in the ENBD group were significantly higher than those in the PTCD group(all P<0.05).Serum AFP,CEA,and CA199 levels in both groups at 1 month after surgery were decreased compared with those before surgery(P<0.05),but there were no statistical differences in serum AFP,CEA,and CA199 levels bet

关 键 词：肝癌 微波消融 经皮肝胆管穿刺引流 经内镜鼻胆管引流 胆管热损伤 置管冷却 

分 类 号：R735.7[医药卫生—肿瘤] R657.4[医药卫生—临床医学]