经皮肝穿刺胆道腔内射频消融联合胆道支架治疗恶性胆道梗阻的初步研究

Percutaneous intraductal radiofrequency ablation plus biliary stenting for malignant biliary obstruction

目的探讨经皮肝穿刺胆道腔内射频消融技术姑息性治疗恶性梗阻性黄疸的安全性及可行性。方法前瞻性纳入20例恶性梗阻性黄疸且不能外科手术切除患者，行透视下经皮肝穿刺胆道腔内射频消融术，并常规留置金属胆道支架及胆道外引流管，观察手术并发症及黄疸缓解情况并密切随访。结果所有患者均顺利完成胆道腔内射频消融治疗并留置金属胆道支架及胆道外引流管。术后未出现胆道出血、穿孔等并发症，2例患者出现胆管炎，内科保守治疗后好转；7 d黄疸缓解率为65％（13/20）；5例患者在术后因晚期肿瘤严重消耗死亡，余患者均存活；3例患者在术后5～6个月黄疸复发，再次行腔内射频治疗后好转；总体1个月支架通。率100％（20/20），3个月支架通。率100％（20/20），6个月支架通。率85％（17/20）；1个月存活率100％（20/20），3个月存活率95％（19/20），6个月存活率75％（15/20）。结论作为一种新式的姑息治疗手段，经皮肝穿刺胆道腔内射频消融对恶性胆道梗阻的治疗是安全和可行的，初步疗效令人满意，但尚需大量样本的随机性及前瞻性研究，远期疗效有待进一步探讨。

Objective To evaluate the safety and feasibility of percutaneous intraductal radiofrequency ablation（ RFA） for malignant obstructive jaundice .Methods 20 patients unable to surgical resection of malignant obstructive jaundice were selected for this study prospectively , these patients underwent percutaneous intraductal biliary radiofrequency ablation.Following ablation,they had a metal stent inserted and a external drainage tube .All the patients were closely observed and followed up after the procedure .Results The intraductal RFA was achieved in all patients successfully and left metal biliary stents and external biliary drainage tube .No complications such as biliary bleeding and perforation , cholangitis occurred in two cases , which were cured with conservative treatment . Jaundice remission rate in seven days was 65%（13/20）;Five patients dead of serious drain with advanced tumors , others were survival .Jaundice recurrence occurred in 3 patients with 5-6 months after the procedure ,were controlled after received the interventional treatment again .The 1-month patency rate was 100%（ 20/20 ） , the 3 month and 6 month patency rate was 100%（20/20）and 85%（17/20）.The 1-month survival rate was 100%（20/20）,3-month and 6-month survival rate was 95%（19/20）and 75%（15/20）.Conclusion As a new kind of palliative treatment , percutaneous intraductal radiofrequency ablation is safe and feasible for malignant biliary obstruction .The short-term outcome is satisfying,but randomness and prospective studies are needed to evaluate the long -term efficacy.