射频消融导管联合支架治疗恶性梗阻性黄疸

Clinical research of percutaneous intraductal radiafrequency 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（RFA）联合支架介入治疗恶性梗阻性黄疸的疗效及安全性。方法纳入无法行手术切除的恶性梗阻性黄疸患者共13例,均接受经皮肝穿刺胆道腔内RFA联合支架植入术,观察手术并发症、黄疸缓解情况并密切随访术后1个月、3个月、6个月支架畅通情况及生存时期。结果所有患者均成功接受手术治疗,术后无胆道穿孔、胆漏、胆汁性腹膜炎等严重并发症发生,术后1周患者血清总胆红素水平较术前显著降低（t=5.156,P〈0.01）,黄疸缓解率为61.5%。随访术后1个月、3个月支架通畅率均为100%,6个月支架通畅率为80%（8/10）。1个月存活率为100%（13/13）,3个月存活率为92%（12/13）,6个月存活率为77%（10/13）,其中2例分别于65 d、132 d后死于晚期肿瘤严重消耗,1例97 d后死于弥散性血管内凝血。2例患者在术后4~5个月内黄疸复发,再次行RFA并重新放入金属支架。结论射频消融导管联合支架植入治疗在短期内能有效且安全延长恶性梗阻性黄疸患者胆道支架通畅时间及无症状时间,其远期疗效尚需进一步探讨。

Objective To investigate the safety and feasibility of percutaneous intraductal radiafrequency ablation（RFA） plus biliary stenting in the treatment of malignant biliary obstruction. Methods A total of 13 patients with unresectable malignant obstructive jaundice were selected to undergo percutaneus intraductal radiofrequency ablation plus metallic biliary stent placement. Clinical efficacy was evaluated by observing the operative complications, remission of jaundice, and the stent patency and survival rate at 1, 3, 6 months were also recorded. Results Patients were successfully received the intraductal RFA. No complications such as perforation, biliary leakage or bile peritonitis occurred. Serum total bilirubin was significantly decreased in 1 week（t=5.156, P〈0.01）,and the jaundice remission rate was 61.5%. The 1, 3 month patency rate was 100%, the 6month patency rate was 80%（8/10）. The 1 month survival rate was 100%, The 3, 6 month survival rate was 92%（12/13）and 77%（10/13）respectively. Two patients dead of serious drain with advanced tumors in 65,132 days after operation respectively, and one patient dead of disseminated intravascular coagulation in 97 days. Jaundice recurrence occurred in two patients in 4~5months after the procedure were controlled after received the interventional treatment again. Conclusion Percutaneous intraductal radiafrequency ablation（RFA） could prolong the malignant biliary obstruction patients’ stent patency and life time effectively and safely, while its long-term efficacy needs to be further proved.