目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆...目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆管恶性肿瘤致梗阻性黄疸患者,采用简单随机分组方法,分为对照组和观察组,每组各45例。对照组患者采用PTCD治疗,观察组患者采用ERCP置入金属支架治疗。比较两组患者的住院天数、术后黄疸缓解率、术后腹痛、术后发热、支架通畅时间、术后并发症发生情况及总生存期等差异。结果观察组患者的住院天数[(12.53±3.98)d]较对照组[(18.77±4.26)d]明显缩短,差异具有统计学意义(P<0.01)。观察组和对照组患者的术后黄疸缓解率(93.33%vs.84.44%)和发热发生率(24.44%vs.33.33%)比较,差异均无统计学意义(P>0.05);观察组患者的术后腹痛发生率(8.89%)较对照组(31.11%)明显下降,差异具有统计学意义(P<0.05);观察组和对照组患者的腹痛消失时间(6.95±1.35 d vs.7.38±1.46 d)和体温恢复正常时间(2.48±0.69 d vs.2.74±0.83 d)比较,差异均无统计学意义(P>0.05)。观察组患者的支架通畅时间[(224.85±48.95)d]和总生存期[(331.14±46.84)d]较对照组[(157.89±42.16)d、(223.16±39.80)d]明显延长,差异具有统计学意义(P<0.01)。观察组患者的术后并发症总发生率(6.67%)较对照组(26.67%)明显降低,差异具有统计学意义(P<0.05)。结论对肝外胆管恶性肿瘤致梗阻性黄疸患者而言,ERCP置入金属支架与PTCD的效果相当,均可有效缓解胆道梗阻性黄疸。但相比于PTCD,ERCP置入金属支架治疗后胆道通畅时间延长,住院时间缩短,并发症发生率低,可促进患者肝功能恢复,延长生存时间,因此,ERCP置入金属支架治疗可作为临床治疗此类患者的一种安全、有效的方法。展开更多
Hepatocellular carcinoma (HCC) is one of the most common malignancies, ranking the sixth in the world, with 55% of cases occurring in China. Usually, patients with HCC did not present until the late stage of the disea...Hepatocellular carcinoma (HCC) is one of the most common malignancies, ranking the sixth in the world, with 55% of cases occurring in China. Usually, patients with HCC did not present until the late stage of the disease, thus limiting their therapeutic options. Although surgical resection is a potentially curative modality for HCC, most patients with intermediate-advanced HCC are not suitable candidates. The current therapeutic modalities for intermediate-advanced HCC include: (1) surgical procedures, such as radical resection, palliative resection, intraoperative radiofrequency ablation or cryosurgical ablation, intraoperative hepatic artery and portal vein chemotherapeutic pump placement, two-stage hepatectomy and liver transplantation; (2) interventional treatment, such as transcatheter arterial chemoembolization, portal vein embolization and image-guided locoregional therapies; and (3) molecularly targeted therapies. So far, how to choose the therapeutic modalities remains controversial. Surgeons are faced with the challenge of providing the most appropriate treatment for patients with intermediate-advanced HCC. This review focuses on the optional therapeutic modalities for intermediateadvanced HCC.展开更多
文摘目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆管恶性肿瘤致梗阻性黄疸患者,采用简单随机分组方法,分为对照组和观察组,每组各45例。对照组患者采用PTCD治疗,观察组患者采用ERCP置入金属支架治疗。比较两组患者的住院天数、术后黄疸缓解率、术后腹痛、术后发热、支架通畅时间、术后并发症发生情况及总生存期等差异。结果观察组患者的住院天数[(12.53±3.98)d]较对照组[(18.77±4.26)d]明显缩短,差异具有统计学意义(P<0.01)。观察组和对照组患者的术后黄疸缓解率(93.33%vs.84.44%)和发热发生率(24.44%vs.33.33%)比较,差异均无统计学意义(P>0.05);观察组患者的术后腹痛发生率(8.89%)较对照组(31.11%)明显下降,差异具有统计学意义(P<0.05);观察组和对照组患者的腹痛消失时间(6.95±1.35 d vs.7.38±1.46 d)和体温恢复正常时间(2.48±0.69 d vs.2.74±0.83 d)比较,差异均无统计学意义(P>0.05)。观察组患者的支架通畅时间[(224.85±48.95)d]和总生存期[(331.14±46.84)d]较对照组[(157.89±42.16)d、(223.16±39.80)d]明显延长,差异具有统计学意义(P<0.01)。观察组患者的术后并发症总发生率(6.67%)较对照组(26.67%)明显降低,差异具有统计学意义(P<0.05)。结论对肝外胆管恶性肿瘤致梗阻性黄疸患者而言,ERCP置入金属支架与PTCD的效果相当,均可有效缓解胆道梗阻性黄疸。但相比于PTCD,ERCP置入金属支架治疗后胆道通畅时间延长,住院时间缩短,并发症发生率低,可促进患者肝功能恢复,延长生存时间,因此,ERCP置入金属支架治疗可作为临床治疗此类患者的一种安全、有效的方法。
基金Supported by the National Natural Science Foundation of China, No. 81071996
文摘Hepatocellular carcinoma (HCC) is one of the most common malignancies, ranking the sixth in the world, with 55% of cases occurring in China. Usually, patients with HCC did not present until the late stage of the disease, thus limiting their therapeutic options. Although surgical resection is a potentially curative modality for HCC, most patients with intermediate-advanced HCC are not suitable candidates. The current therapeutic modalities for intermediate-advanced HCC include: (1) surgical procedures, such as radical resection, palliative resection, intraoperative radiofrequency ablation or cryosurgical ablation, intraoperative hepatic artery and portal vein chemotherapeutic pump placement, two-stage hepatectomy and liver transplantation; (2) interventional treatment, such as transcatheter arterial chemoembolization, portal vein embolization and image-guided locoregional therapies; and (3) molecularly targeted therapies. So far, how to choose the therapeutic modalities remains controversial. Surgeons are faced with the challenge of providing the most appropriate treatment for patients with intermediate-advanced HCC. This review focuses on the optional therapeutic modalities for intermediateadvanced HCC.
