RFA联合胆道自扩式金属支架植入对恶性胆道梗阻患者生化指标及预后的影响

Effect of percutaneous transhepatic biliary radiofrequerncy combined with biliary self-expandable metallic stent implantation on biochemical indexes,prognosis and survival time of patients with malignant biliary obstruction

目的探讨经皮肝穿刺胆道内消融(RFA)联合胆道自扩式金属支架植入(SEMS)对恶性胆道梗阻患者实验室指标及预防的影响。方法以宜宾市第一人民医院2014年1月~2017年1月收治的82例恶性胆道梗阻患者为对象,按入院顺序编号随机分为对照组(接受SEMS治疗,n=41)和联合组(实施RFA联合SEMS治疗,n=41),观察两组手术前后实验室指标[总胆红素(TBIL)、谷氨酸氨基转移酶(ALT)、谷氨酰氨基转肽酶(γ-GT)、白蛋白]、术后支架通畅率、随访生存情况和并发症发生情况。结果术前两组TBIL、ALT、γ-GT、白蛋白比较无明显差异(P>0.05);与术前比较,术后两组TBIL、ALT、γ-GT明显降低,白蛋白明显升高,且术后联合组各项指标变化幅度较对照组明显(P<0.05);术后9、12个月联合组支架通畅率(92.68%、87.80%)较对照组(73.17%、68.29%)明显提高(P<0.05);两组术后6个月生存率相较无明显差异(P>0.05),但术后12个月联合组生存率较对照组明显升高,且联合组平均生存时间较对照组明显延长(P<0.05);术后联合组并发症发生率与对照组比较差异无统计学意义(χ2=0.497,P>0.05)。结论 RFA联合SEMS治疗恶性胆道梗阻患者时,其在降低实验室肝功能指标、提高白蛋白水平、提高中后期支架通畅率以及延长生存期方面的积极作用较单一SEMS更具优势,可作为无外科手术指征的恶性胆道梗阻患者的一种安全有效治疗方案。

Objective To investigate the effect of percutaneous transhepatic biliary radiofrequerncy（RFA）combined with biliary self-expandable metallic stent（SEMS）implantation on laboratory indexes in patients with malignant biliary obstruction.Methods 82 patients with malignant biliary obstruction treated in Yibin First People＇s Hospital were selected as the subjects.They were randomly divided into the control group（treated with SEMS,n=41）and the combined group（treated with RFA combined with SEMS,n=41）according to the order of admission.Laboratory indexes[total bilirubin（TBIL）,alanine aminotransferase（ALT）,γ-glutamyl transpeptidase（γ-GT）,albumin],postoperative stent patency rate,survival and the incidence of complications in two groups were observed.Results There was no significant difference of TBIL,ALT,γ-GT and albumin between the two groups before operation（P〉0.05）.After operation,levels of TBIL,ALT andγ-GT decreased significantly while albumin increased significantly in two groups,and changes of above-mentioned indexes in combined group were greater than those in the control group（P〈0.05）.The patency rates of stent in the combined group at 9 months and 12 months after operation（92.68%and 87.80%）were significantly higher than those in the control group（73.17% and 68.29%）（P〈0.05）.There was no significant difference of survival rate between the two groups at 6 months after operation（P〉0.05）,but the survival rate of the combined group was significantly higher than that of the control group at 12 months after operation,and the average survival time of the combined group was significantly longer than that of the control group（P〈0.05）.There was no significant difference in the incidence of postoperative complications between the two groups（χ2=0.497,P〉0.05）.Conclusion RFA combined with SEMS has more advantages over SEMS alone in the treatment of malignant biliary obstruction,in terms of reducing laboratory liver function indexes,increasing albumin levels,improving stent patency rate and prolonging the survival time.