经皮肝穿刺胆道引流联合CT引导下微波消融治疗肝门区胆管癌的疗效分析

PTCD combined with CT-guided microwave ablation for hepatic hilar cholangiocarcinoma: analysis of therapeutic efficacy

目的探讨经皮肝穿刺胆道引流联合CT引导下微波消融（MWA）治疗肝门区胆管癌的应用价值。方法回顾性分析自2012年12月至2014年8月29例不可手术切除的Ⅲ、Ⅳ型肝门区胆管癌伴梗阻性黄疸患者。经病理证实胆管腺癌，其中19例行胆道内外引流术，4例行胆道外引流术，6例行左右两侧胆管引流术，待肝功能改善后，行肝门区肿块MWA治疗，29例患者完成46次消融治疗，每便呼均1．5次，术后4—8周复查肝功能、增强CT或者MR，采用mRECIST标准评价肿瘤治疗疗效。观察患者的胆红素变化，随访其进展及生存时间。结果术后1个月完全缓解（CR）15例（15／29，51．7％）、部分缓解（PR）17例（17／29，58．6％），整体有效率82％（CR＋PR），1例患者术后出现肝内转移，1例出现肺转移，29例患者术后胆红素均明显下降，6个月、1年、2年生存率分别为68．9％（20／29），31．0％（9／29），6．8％（2／29），中位生存期（MST）8．9个月，总生存期（OS）11．7个月。结论经皮肝穿刺胆道引流联合CT引导下MWA治疗肝门区胆管癌是微创、安全、有效的治疗方法。

Objective To discuss the clinical application of percutaneous transhepatic cholangiopancreatic drainage （PTCD） combined with CT-guided microwave ablation in treating hepatic hilar cholangiocarcinoma. Methods The clinical data of 29 patients with inoperable IU and IV type hilar cholangiocarcinoma complicated by obstructive jaundice, who were admitted to authors＇ hospital during the period from December 2012 to August 2014, were retrospectively analyzed. The diagnosis of bile duct adenocarcinoma was confirmed by pathology in all patients. Of the 29 patients, both internal and external biliary tract drainage was employed in 19, external biliary tract drainage in 4, and bilateral （both left and fight side） bile duct drainage in 6. CT-guided microwave ablation was carried out when the liver function became improved. A total of 46 procedures of microwave ablation were completed in the 29 patients with a mean of 1.5 times per patient. Hepatic function tests, enhanced CT or MR scan were performed 4-8 weeks after treatment. According to mRECIST criteria the therapeutic results were evaluated; the serum bilirubin levels were recorded; the disease progress and the patient＇s survival time were followed up. Results One month after the treatment, complete response （CR） was obtained in 15 patients （15/29, 51.7%）, and partial remission （PR） in 17 patients （17/29, 58.6%）, with the overall efficacy （CR＋PR） being 82%. After the treatment, one patient developed hepatic metastasis and another one had pulmonary metastasis. Postoperative serum bilirubin levels showed an obvious decrease in all 29 patients. The 6-month, one-year and two-year survival rates were 68.9% （20/29）, 31.0% （9/29） and 6.8% （2/29） respectively; the median survival time was 8.9 months and the overall survival time was 11.7 months. Condutsion For the treattllelat of hepatic hilar chotangiocarcinoma, PTCD combined with CT-guided microwave ablation is minimally invasive, clinically safe and effective. （ J Intervent Radiol, 2015, 24 ： 811-814）