腔内射频消融治疗胆管恶性狭窄的初步研究

Intraductal radiofrequency ablation for malignant biliary strictures

目的探讨内镜下应用腔内射频消融技术姑息性治疗胆管恶性狭窄的安全性及可行性。方法前瞻性选取胆管恶性梗阻无法手术切除的12例患者实施ERCP，在胆管插管成功后，循导丝导入专用双极射频电极，于肿瘤部位进行射频烧灼，然后留置胆道支架，观察术后恢复情况并密切随访。结果所有患者均成功完成射频消融治疗并留置胆道支架（塑料支架6例，金属支架6例，其中3例患者同期放置胰管支架）。出现胆管炎1例，胰腺炎1例，均短期保守治疗控制。黄疸迅速缓解率为58．3％（7／12）；平均随访3．4个月（0．5～5．5个月），1个月末支架通畅率为100％（12／12），3个月末通畅率为80％（8／10）；1例患者死于心脑血管意外，其余患者均存活无特殊不适。结论对于胆管恶性狭窄，经内镜进行腔内射频治疗是安全可行的，初步疗效满意，但远期疗效及最佳治疗方案仍有待进一步探讨。

Objective To evaluate the feasibility and safety of endoscopic intraductal radiofrequency ablation （RFA） for unresectable malignant biliary strictures. Methods A total of 12 patients with malignant biliary obstructions, who were unsuitable for surgical resection, were prospectively selected for this study. During ERCP, when successful biliary eannulation achieved, a bipolar radiofrequency probe was introduced into bile duct over a guidewire. RFA was given to the tumor lesion under fluoroscopy, followed by stent placement. The patients were closely observed and followed up after the procedure. Results Success- ful RFA was achieved in all patients before stents insertion （ plastic and metal stents in 6 respectively, addi- tional pancreatic stents were given to 3 ）. Mild complications of cholangitis and pancreatitis occurred in 1 patient respectively, which were cured with short-term management. Jaundice was promptly controlled in 7 patients （58.3%）. During the mean follow-up duration of 3.4 （range 0. 5-5.5 ） months, one patient died of cardiocerebral accident and others survived without obvious discomfort. The 1- month and 3- month stent patency was 100% （12/12） and 80% （8/10）, respectively. Conclusion It is technically feasible and safe to perform endoscopic intraductal RFA for the palliation of biliary malignancies. The short-term outcome is satisfying, however, long-term resuh and the better therapeutic schedule need further evaluation.