SpyGlass下姑息性射频消融联合置入胆管支架治疗胆管恶性狭窄的疗效分析

Clinical value of SpyGlass direct visualization system-guided radiofrequency ablation combined with biliary stent implantation in the treatment of malignant biliary strictures

目的分析SpyGlass系统直视下射频消融联合置入胆管支架治疗胆管恶性狭窄的临床价值。方法回顾分析2020年4月至2022年6月在南京大学医学院附属鼓楼医院和无锡市第二人民医院行姑息性内镜治疗的29例胆管恶性狭窄患者资料,其中男性20例,女性9例,年龄(70.3±11.5)岁。29例患者中行SpyGlass直视下射频消融联合置入胆管支架治疗的纳入联合组(n=14),单纯置入胆管支架纳入支架组(n=15)。比较两组年龄、性别、原发肿瘤、体质量指数、术前和术后总胆红素、黄疸缓解率、术后并发症(胆漏、出血、胆管炎等)、支架通畅时间以及术后生存率。结果29例患者中胆管癌20例(69.0%)、肝细胞癌4例(13.8%)、胆囊癌3例(10.3%)、壶腹癌2例(6.9%)。两组年龄、男性比例、原发肿瘤、体质量指数及术前总胆红素等比较,差异均无统计学意义(均P>0.05)。联合组术后总胆红素为41.5(29.8,52.5)μmol/L,支架组术后总胆红素为55.4(31.5,107.1)μmol/L,两组比较差异无统计学意义(Z=1.18,P=0.247)。联合组黄疸缓解11例,支架组黄疸缓解10例,两组黄疸缓解率比较,差异无统计学意义(χ^(2)=0.51,P=0.474)。联合组支架通畅时间为90(77,250)d,支架组支架通畅时间为100(60,190)d,两组比较差异无统计学意义(Z=0.28,P=0.793)。两组术后累积生存率和术后并发症发生率比较,差异均无统计学意义(均P>0.05)。结论SpyGlass系统直视下姑息性射频消融联合置入胆管支架治疗胆管恶性狭窄并不能提高疗效和延长支架通畅时间。

ObjectiveTo study the clinical value of SpyGlass direct visualization system-guided radiofrequency ablation(RFA)combined with biliary stent implantation in the treatment of malignant biliary stricture.MethodsClinical data of 29 patients with advanced malignant biliary stricture without surgical resectability who received palliative endoscopic treatment in Drum Tower Hospital of Nanjing University Medical School and Wuxi No.2 People’s Hospital were retrospectively analyzed,including 20 males and 9 females,aged(70.3±11.5)years.Patients were divided into two groups:the SpyGlass-guided biliary RFA combined with biliary stent implantation treatment group(combined group,n=14)and the simple biliary stent treatment group(simple stent group,n=15).The age,gender,body mass index(BMI),the total bilirubin,jaundice remission,postoperative complications,stent patency time and survival period were compared between the two groups.ResultsAmong 29 cases,20 were cholangiocarcinoma(69.0%),4 were hepatocellular carcinoma(13.8%),3 were carcinoma of gallbladder(10.3%),and 2 were ampullary carcinoma(6.9%).There were no statistically significant difference in age,male proportion,primary tumor proportion,BMI and total bilirubin between the groups(all P>0.05).The postoperative total bilirubin of the combined group was 41.5(29.8,52.5)μmol/L,and that of the stent group was 55.4(31.5,107.1)μmol/L(Z=1.18,P=0.247).There were 11 cases of jaundice remission in the combined group and 10 in the stent group(χ^(2)=0.51,P=0.474).The stent patency time in the combined group was 90(77,250)days,and that in the stent group was 100(60,190)days(Z=0.28,P=0.793).There was no significant difference in cumulative survival rates and incidence of postoperative complications between the two groups(P>0.05).ConclusionSpyGlass-guided biliary RFA combined with biliary stent implantation neither improves the treatment efficacy nor prolongs stent patency time in patients with malignant biliary strictures.