射频消融术联合内镜金属支架治疗无法手术切除的胆管癌患者44例的疗效观察

The efficacy of the combination of radiofrequency ablation and endoscopic metal stent in the treatment of 44 patients with unresectable cholangiocarcinoma

目的探索射频消融术(RFA)联合内镜金属支架治疗无法手术切除的胆管癌患者的疗效。方法回顾性收集2012年1月3日至2019年6月30日在海军军医大学第三附属医院内镜科行RFA联合内镜金属支架治疗无法手术切除的44例胆管癌患者的临床资料,包括年龄、性别、胆管癌部位(肝门部胆管癌和远端胆管癌)等。结合随访情况进行术后评估,包括临床成功率、术后并发症发生率、支架通畅期和总生存时间(OS)。采用Kaplan-Meier法和log-rank检验分析肝门部胆管癌与远端胆管癌患者OS的差异。统计学方法采用Mann-WhitneyU检验。结果 44例胆管癌患者的年龄为(70.3±11.6)岁,男性20例(45.5%),肝门部胆管癌和远端胆管癌患者各22例(50.0%)。44例患者的临床成功率为93.2%(41/44)。共有5例(11.4%)患者出现了术后并发症,均通过相应治疗好转。44例患者的中位随访时间(范围)为9.2个月(3.1~57.6个月),中位支架通畅期(范围)为7.0个月(5.8~8.2个月),共有32例(72.7%)患者死亡,中位OS(范围)为10.9个月(9.0~12.8个月)。肝门部胆管癌患者的中位OS(范围)为7.8个月(4.6~11.0个月),远端胆管癌患者的中位OS(范围)为12.5个月(5.7~19.4个月),差异无统计学意义(P>0.05)。结论 RFA联合内镜金属支架治疗无法手术切除的胆管癌患者是安全、有效的。

Objective To explore the efficacy of the combination of radiofrequency ablation(RFA)and endoscopic metal stent in the treatment of patients with unresectable cholangiocarcinoma.Methods From January 3,2012 to June 30,2019,at the Department of Endoscopic of the Third Affiliated Hospital of Naval Medical University,the clinical data of 44 patients with unresectable cholangiocarcinoma who were treated by the combination of RFA and endoscopic metal stent were retrospectively collected,which included age,gender,location of cholangiocarcinoma(hilar cholangiocarcinoma and distal cholangiocarcinoma),etc.Postoperative evaluation was conducted based on the follow-up,including clinical success rate,postoperative complication rate,time of stent patency and overall survival time(OS).The Kaplan-Meier method and log-rank test were used to analyze the difference of OS between patients with hilar cholangiocarcinoma and distal cholangiocarcinoma.Mann-Whitney U test was used for statistical analysis.Results The age of the 44 patients with cholangiocarcinoma was(70.3±11.6)years old,with 20 males(45.5%).There were 22 patients(50.0%)with hilar cholangiocarcinoma and 22 patients(50.0%)with distal cholangiocarcinoma.The clinical success rate of 44 patients was 93.2%(41/44).A total of 5 patients(11.4%)had postoperative complications,which were all improved by appropriate treatment.The median time of follow-up of the 44 patient was 9.2 months(ranged from 3.1 to 57.6 months),the median time of stent patency was 7.0 months(ranged from 5.8 to 8.2 months).Thirty-two patients(72.7%)died during the follow-up,and the median OS was 10.9 months(ranged from 9.0 to 12.8 months).The median OS of patients with hilar cholangiocarcinoma was 7.8 months(ranged from 4.6 to 11.0 months)and that of patients with distal cholangiocarcinoma was 12.5 months(ranged from 5.7 to 19.4 months),and there was no statistically significant difference(P>0.05).Conclusion RFA combined with endoscopic metal stent is safe and effective in the treatment of patients with unresectable cholangiocarcinoma.