内镜下胆道射频消融联合支架植入治疗恶性胆道梗阻的疗效及安全性分析  

Efficacy and safety analysis of endoscopic biliary radiofrequency ablation combined with stent implantation in the treatment of malignant biliary obstruction

作　　者：王馨祎 王林恒[2] 高霞 贺海艳 孟捷[2] WANG Xinyi;WANG Linheng;GAO Xia;HE Haiyan;MENG Jie(Beijing University of Chinese Medicine,Beijing 100029;Department of Spleen,Stomach,Liver and Gallbladder,Beijing University of Chinese Medicine,Dongfang Hospital,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东方医院脾胃肝胆科

出　　处：《胃肠病学和肝病学杂志》2024年第11期1530-1534,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：北京市科技计划项目(Z161100000516058);第四批全国中医(临床、基础)优秀人才研修项目(国中医药人教发[2017]24号);北京中医药大学重点攻关项目(2020-JYB-ZDGG-132)。

摘　　要：目的评价内镜下胆道射频消融(endoscopic radiofrequency ablation,ERFA)联合支架植入治疗恶性胆道梗阻(malignant biliary obstruction,MBO)的疗效及安全性。方法回顾性分析2019年1月至2023年9月在北京中医药大学东方医院内镜中心行ERFA治疗MBO患者的临床特征和治疗结局。记录并统计分析病例临床特征、操作情况、总生存期(overall survival,OS)、支架通畅时间、临床成功率、早期不良事件。结果纳入的12例病例中,操作时间为(39.5±17.5)min;获得临床成功的患者8例(66.67%);OS为3~27个月,中位OS为4.5个月;总体支架通畅时间为1~6个月,中位支架通畅时间为3个月;不良事件中3例(25.00%)患者术后出现胰腺炎,1例(8.33%)患者术后出现高淀粉酶血症,1例(8.33%)患者术后出现急性胆管炎,1例(8.33%)患者发生术中出血。结论ERFA联合支架植入治疗MBO临床成功率高,可以有效延长患者生存期、胆道支架通畅时间,改善患者生存质量。术前预防性抗感染、术后及时抗感染治疗、规范操作过程均可降低早期不良反应发生率。本研究为回顾性分析且样本量小,故仍需更多大样本、多中心、前瞻性研究进一步验证ERFA治疗MBO的疗效和安全性。Objective To evaluate the efficacy and safety of endoscopic biliary radiofrequency ablation(ERFA)combined with stent implantation in the treatment of malignant biliary obstruction(MBO).Methods The clinical features and treatment outcomes of patients with MBO who received ERFA at the Endoscopy Center of Dongfang Hospital of Beijing University of Chinese Medicine from Jan.2019 to Sep.2023 were retrospectively analyzed.The clinical characteristics,operation conditions,overall survival,stent patency time,clinical success rate,and early adverse events of the cases were recorded and statistically analyzed.Results Among the 12 included cases,the average operation time was(39.5±17.5)minutes,8 patients(66.67%)achieved clinical success.The overall survival was 3-27 months,the median OS was 4.5 months,the stent patency time was 1-6 months,the median stent patency time was 3 months.Among the adverse events,postoperative acute pancreatitis occurred in 3 patients(25.00%),postoperative hyperamylaseemia occurred in 1 patient(8.33%),postoperative acute cholangitis occurred in 1 patient(8.33%),postoperative bleeding occurred in 1 patient(8.33%).Conclusion ERFA combined with stent implantation has a high clinical success rate in the treatment of MBO,which can effectively prolong the overall survival and the stent patency,also can improve the quality of life of patients.Preoperative prophylactic anti-infection,timely postoperative anti-infective treatment,and standardized operation can all reduce the incidence of AE.Due to the retrospective analysis and small sample size of this study,more large-sample,mul-ticenter and prospective studies are needed to verify the efficacy and safety of ERFA in the treatment of MBO.

关 键 词：内镜下胆道射频消融 恶性胆道梗阻 胆管癌 胆道支架 内镜逆行胰胆管造影术 

分 类 号：R575.7[医药卫生—消化系统]