经皮经肝双极射频导管处理恶性胆道梗阻及胆道内支架再堵塞的初步临床观察

Preliminary clinical study of percutaneous transhepatic bipolar radiofrequency ablation catheter in the treatment for malignant biliary obstructive jaundice and biliary stent re-stenosis

目的 初步观察双极射频导管治疗恶性胆道梗阻及胆管内支架再堵塞的可行性和安全性.方法 江苏省肿瘤医院介入科2012年3至6月收治4例晚期肿瘤导致的恶性阻塞性黄疸患者,经皮经肝路径在胆管梗阻段使用经皮穿刺式双极射频导管消融治疗,功率6～8W,使用时间60-120 s,迅速重建通道,恢复胆汁流出路径,进行手术实用性、安全性评价及并发症观察.结果 4例患者消融手术顺利,平均手术时间40 min,30 d内无死亡.无1例大出血、胆瘘、胆道感染、血（气）胸、胆汁胸、胆心综合征、肝贯通伤、胆汁性腹膜炎等并发症.胆道重建术后胆管扩张情况均明显好转,血清总胆红素及直接胆红素指标总体下降.1例胆道内支架阻塞再通患者在术后90 d胆道再次堵塞,4例平均胆道和支架通畅时间124（90～171）d.为进一步抗肿瘤治疗创造了条件.结论 经皮穿刺式双极射频导管可迅速对恶性胆道梗阻及胆管内支架再堵塞进行管道重建,提高治疗效果.

Objective To preliminary observe the feasibility and safety of bipolar radiofrequency ablation catheter in the treatment of malignant biliary obstructive jaundice and biliary stent re-stenosis.Methods Four patients with malignant obstructive jaundice caused by terminal cancer received ablation therapy for biliary obstruction by percutaneous transhepatic bipolar radiofrequency ablation catheter.The normal tunnel of biliary was reconstructed rapidly to restore the outflow tract of bile.The procedural practicality,clinical safety and operative complications were analyzed.Results The ablation therapy was successful for 4 patients.The mean operating duration was 40 min without any 30-day mortality.No postoperative complications such as massive hemorrhage,biliary fistula,biliary infection,hemothorax,pneumothorax,cholothorax,chole-heart syndrome,liver penetrating wound and biliary peritonitis etc.occurred.Cholangiectasis improved markedly after biliary tract reconstruction with general declines of serum total bilirubin and direct bilirubin.One case with biliary stent re-stenosis was re-blocked postoperatively.The average patency time of biliary tract and stent was 124 （90-171） days in 4 cases.Conditions were created for further anti-tumor treatment.Conclusion Percutaneous transhepatic bipolar radiofrequency ablation catheter can reestablish the canal rapidly for malignant biliary obstructive jaundice and stent restenosis so as to enhance the therapeutic efficacy.