经内镜逆行性胰胆管造影术引导下腔内射频消融联合内支架置入治疗恶性胆管肿瘤合并梗阻的疗效及预后分析

Curative efficacy and prognosis of radiofrequency ablation in combination with stent placement guided by endoscopic retrograde cholangio-pancreatography in patients of bile duct cancer complicated with obstruction

摘要:

目的  探讨经内镜逆行性胰胆管造影术引导下腔内射频消融联合内支架置入治疗恶性胆管肿瘤合并梗阻的疗效及预后状况，为临床治疗提供依据。方法  收集89例符合纳入标准的恶性胆管肿瘤合并梗阻患者，按治疗方案分为对照组（n =42）和观察组（n =47）。对照组给予单独经内镜逆行性胰胆管造影术引导下内支架置入治疗，观察组给予经内镜逆行性胰胆管造影术引导下射频消融联合内支架置入治疗。观察比较两组患者手术状况、肝功能指标、黄疸有效缓解率、随访状况及并发症发生状况。结果  两组患者均顺利完成手术治疗。观察组手术时间显著长于对照组，（96.4±32.6） vs （34.8±12.9）min，差异具有显著统计学意义（P <0.05）。置入胆道金属支架47例；肝门部胆管梗阻左、右肝管金属支架和塑料支架联合置入6例，双塑料支架36例。其中胆管低位梗阻者同时置入胆道金属支架和胰管支架者19例。术后1周，观察组血清总胆红素、γ谷氨酰转移酶和碱性磷酸酶水平均显著低于对照组，（74.4±22.9） vs （109.2±28.7）μmol/L，（297.6±76.8） vs （387.4±89.3） u/L，（203.4±72.6） vs （278.7±84.3）u/L；黄疸有效缓解率显著高于对照组，97.9% vs 81.0%，差异均具有统计学意义（P 均<0.05）。观察组胆道通畅时间和生存时间均显著长于对照组，（9.7±2.1） vs （6.1±1.7）个月，（16.9±4.2） vs （10.6±3.7）个月；12个月存活率显著高于对照组，55.3% vs 28.6%，差异均具有统计学意义（P < 0.05）。两组患者均未发生严重并发症，观察组与对照组并发症发生率差异无统计学意义，21.2% vs 16.7%（P >
0.05）。结论  经内镜逆行性胰胆管造影术引导下射频消融联合内支架置入治疗恶性胆道肿瘤合并梗阻，手术简单可行，可以有效缓解黄疸并改善肝功能指标，延长胆道通畅和患者生存时间，值得临床上值得进一步研究和推广应用。

Abstract:

Objective To investigate the curative efficacy and prognosis of radiofrequency ablation in combination with stent placement guided by endoscopic retrograde cholangio-pancreatography in patients of bile duct cancer complicated with obstruction. Methods According to therapeutic schemes, 89 cases of bile duct cancer complicated with obstruction were divided into two groups. The control group (CG) was treated with stent placement guided by endoscopic retrograde cholangio-pancreatography while the observation group (OG) was treated with radiofrequency ablation in combination with stent placement guided by endoscopic retrograde cholangio-pancreatography. The surgical status, liver function index, jaundice remission rate, follow-up results and postoperative complications were observed and compared. Results Two groups were all received success surgery. The length of surgery was significantly longer in OG than in CG [(96.4 ± 32.6) vs (34.8 ± 12.9) min, P < 0.05]. One week after surgery, levels of serum total bilirubin, gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) were all significantly lower in OG than in CG [(74.4 ± 22.9) vs (109.2 ± 28.7) μmol/L, (297.6 ± 76.8) vs (387.4 ± 89.3) U/L, (203.4 ± 72.6) vs (278.7 ± 84.3) U/L, P < 0.05]. The jaundice remission rate of OG was significantly higher than that of CG (97.9% vs 81.0%, P < 0.05). The patency time of biliary tract and survival time in OG were both longer than those in CG [(9.7 ± 2.1) vs (6.1 ± 1.7) months, (16.9 ± 4.2) vs (10.6 ± 3.7) months, P < 0.05]. The survival rate of 12 months of OG was higher than that of CG (55.3% vs 28.6%, P < 0.05). Both two groups had no serious postoperative complication. The complications rates of 2 groups had no significant difference (21.2% vs 16.7%, P > 0.05). Conclusions Radiofrequency ablation in combination with stent placement guided by endoscopic retrograde cholangio-pancreatography in patients of bile duct cancer complicated with obstruction can increase jaundice remission rate, patency time of biliary tract and survival time.