经皮经肝胆管腔内射频消融疏通肝门部胆管癌性梗阻

Percutaneous transhepatic cholangio/endobiliary radiofrequency ablation for recanalizing hilar cholangiocarcinoma obstruction

经皮经肝胆管腔内射频消融(PTC/EB-RFA)是胆管疾病介入治疗的新技术之一。由于肝门部解剖结构的复杂性和介入手术的高风险性,特别是晚期癌性梗阻和实施了毕Ⅱ式或Roux-en-Y胆肠吻合以及经口/鼻内镜逆行胰胆管造影(ERCP)操作失败者,难以实施经ERCP途径的胆管腔内射频消融(EB-RFA)。本文报告1例基于三维重建CT(3D+CT)和超声等多模态影像精准引导的PTC/EB-RFA,回顾分析了相关临床资料和文献,总结了基本操作技术和临床影像判读经验,以进一步提高PTC/EB-RFA临床应用的安全性和有效性。

Percutaneous transhepatic cholangio/endobiliary radiofrequency ablation(PTC/EB-RFA)is one of the new interventional therapies in the management of benign and malignant biliary lesions.Duo to the complex anatomy and high risk operation close to central bile ducts,PTC/EB-RFA recanalization of hilar cholangiocarcinoma obstruction is challenging,especially in the patient with advanced-stage carcinoma or undergoing distal gastrectomy with BillrothⅡreconstruction or bilioenteric Roux-en-Y anastomosis,in which endoscopic retrograde cholangio-pancreato-graphy(ERCP)failed.This article reported on the detailed technical aspects of PTC/EB-RFA based on precise guidance of multimodal 3D+CT and ultrasound images,and the clinical experience and literatures were reviewed to improve the safety and success of this procedure.