内镜下射频消融联合支架植入治疗恶性梗阻性黄疸的临床效果

Clinical effect of endoscopic radiofrequency ablation combined with stent implantation in the treatment of malignant obstructive jaundice

目的 探索内镜下射频消融联合支架植入治疗恶性梗阻性黄疸的临床效果.方法 回顾性分析50例诊断为恶性梗阻性黄疸患者的临床资料,依据不同治疗方案将患者分为联合组(28例)和支架组(22例).联合组采用内镜下射频消融联合支架植入治疗,支架组仅行内镜下支架植入治疗.分析两组手术情况、术后并发症发生情况、血清总胆红素水平、肝功能、黄疸缓解率、支架通畅率及生存率.结果 联合组手术时间长于支架组(P<0.05).术后3、7 d,两组ALP、γ-GGT、ALT、AST水平均较术前显著下降(P<0.05);但组间同一时间比较,差异无统计学意义(P>0.05).术后1、3个月,两组支架通畅率及生存率比较,差异无统计学意义(P>0.05);术后6个月,联合组患者支架通畅率及生存率均明显高于支架组,差异具有统计学意义(P<0.05).结论 内镜下射频消融联合支架植入治疗恶性梗阻性黄疸患者能提高支架通畅率及生存率,对于失去根治性手术切除机会或不愿意及不适合根治性手术者是一种有效的姑息性治疗方案.

Objective To explore the clinical effect of endoscopic radiofrequency ablation combined with stent implantation in the treatment of malignant obstructive jaundice.Methods The clinical data of 50 patients with malignant obstructive jaundice were analyzed retrospectively.According to different treatment schemes,the patients were divided into combined group(28 cases)and stent group(22 cases).The combined group was treated with endoscopic radiofrequency ablation and stent implantation,while the stent group was treated only with endoscopic stent implantation.The operation situation,postoperative complications,serum total bilirubin level,liver function,jaundice relief rate,stent patency rate and survival of the two groups were analyzed.Results The operation time of the combined group was longer than that of the stent group(P<0.05).At 3,7 days after operation,the levels of ALP,γ-GGT,ALT and AST in the two groups were significantly lower than those before operation(P<0.05);but there were no statistical significances between the groups at the same time(P>0.05).At 1 and 3 months after operation,there were no significant differences between the two groups in stent patency rate and survival rate(P>0.05);at 6 months after operation,the stent patency rate and survival rate in the combined group were significantly higher than those in the stent group,the differences were statistically significant(P<0.05).Conclusion Endoscopic radiofrequency ablation combined with stent implantation can improve the patency rate of stent and survival rate in patients with malignant obstructive jaundice.It is an effective palliative treatment for the patients who are not willing or suitable for radical surgery.