内镜下射频消融联合金属支架植入对不可切除胆管癌的疗效

Endoscopic radiofrequency ablation combined with metal stent implantation and simple metal stent implantation forunrespectable cholangiocarcinoma

目的回顾性分析内镜下射频消融联合金属支架植入术对不可切除胆管癌引起的胆道梗阻的治疗效果。方法本研究纳入自2013年6月至2016年6月我科收治的47例不可切除胆管癌患者,其中实验组(n=24)经内镜ERCP行胆道腔内射频消融联合金属支架植入术,对照组(n=23)经内镜ERCP行单纯金属支架植入术。观察分析两组患者手术引流情况、肝功能指标、并发症、支架通畅率、生存率。结果所有患者均顺利完成手术,术后1周,实验组血清中总胆红素(TBIL)、碱性磷酸酶(ALP)、γ谷氨酰胺转移酶(GGT)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平均显著低于对照组(P<0.05)。术后随访14~50个月,实验组支架通畅率高于对照组(P<0.05),实验组支架通畅时间和生存时间高于对照组,(8.56±1.12)vs.(5.73±0.81)个月,(13.88±1.45)vs.(9.48±1.38)个月,差异具有统计学意义(P<0.05)。所有病例均未出现术后大出血、穿孔等严重并发症,8例患者出现术后胆道感染和血淀粉酶升高,予以抗感染、抑酶等对症治疗后好转。结论内镜下射频消融联合金属支架植入术治疗不可切除胆管癌的效果明显优于单纯金属支架植入术。

Objective To retrospectively analyze the therapeutic effect of endoscopic ablation combinedwith metal stent implantationon biliary obstruction caused by unrespectable cholangiocarcinoma. Methods Fourty-seven patients with unrespectable cholangiocarcinoma were enrolled in this study,who were treated in our depart-ment from June 2013 to June 2016. Patients in the experimental group（n = 24）underwent ERCP combined withmetal stent implantation for biliary tract ablation. Patients inthe control group（n = 23）underwent ERCP with simplemetal stent implantation. Liver function indicators,complications,patency rate and survival rate were analyzed be-tween the two groups. Results A total of 51 patients were satisfactorily performed the operation of metal stent im-plantation. One week after operation,the levels of total bilirubin（TBIL）,alkaline phosphatase（ALP）,gamma-glu-tamyltransferase（GGT）and alanine aminotransferase（AST）in the experimental group were much lower than thosein the control group（P〈0.05,respectively）. After 3-month follow-up,the patency rate in the experimental groupwas significantly greater than that in the control group（P〈0.05）. The patency and survival time of patients in theexperimental group were significantly higher than thosein the control group,with 8.56±1.12 vs 5.73±0.81 monthsand 13.88±1.45 vs 9.48±1.38 months,respectively（P〈0.05）. No postoperative bleeding,perforation and other se-rious complications were found in all cases,8 patients with postoperative biliary tract infection and the increasedblood amylase received anti-infective treatments,such as inhibition of symptomatic improvement after treatment.Conclusion The results of endoscopic radiofrequency ablation combined with metal stent implantation for the treat-ment of unrespectable cholangiocarcinoma were significantly better than those of simple metal stent implantation.