射频消融联合支架植入术治疗恶性胆道梗阻

目的探讨射频消融联合支架植入术治疗恶性胆道梗阻的临床应用价值。方法选取恶性胆道梗阻的患者34例,对其中19例行射频消融联合胆道金属支架植入术(射频组),15例行单纯胆道金属支架植入引流术(引流组)。记录术前、术后5天和7天的血清总胆红素(TBIL),及术后胆瘘、胆道穿孔、胰腺炎及胆管炎的发生率。分别于术后3、6、12个月进行电话随访,记录支架通畅率、生存率及生存时间,并进行统计学分析。结果对两组患者均顺利完成手术,无胆瘘、胆道穿孔、胆道出血、胰腺炎发生。两组术前、术后5天和7天TBIL水平差异均无统计学意义(P均0.05)。10例出现胆管炎(射频组6例,引流组4例),两组差异无统计学意义(P0.05)。术后3、12个月支架通畅率及术后3、6、12个月生存率差异均无统计学意义(P均0.05)。射频组术后6个月支架通畅率高于引流组(P0.05)。射频组生存时间长于引流组(P0.05)。结论射频消融联合支架植入术可提高术后6个月支架通畅率并延长患者生存时间,可作为治疗胆道恶性梗阻的重要方法之一。     

内镜射频消融联合支架置入技术治疗晚期胆道恶性梗阻8例临床分析

目的探讨经内镜射频消融联合支架置入技术治疗晚期胆道恶性梗阻的安全性及疗效。方法我院于2013.11-2014.6期间,共对8例无法手术切除的胆道恶性梗阻患者实施经内镜射频消融联合支架置入技术进行治疗,在胆管插管成功后,循导丝导入专用双极射频电极,于肿瘤部位进行射频消融,每次射频消融功率为8~10瓦,消融时间90~120秒,然后留置胆道支架,观察术后恢复情况并密切随访。结果所有患者均成功完成射频消融治疗并留置胆道塑料支架(其中1例同期放置胰管支架)。1例出现继发性胆囊炎,急诊行开腹胆囊切除术。2例出现高淀粉酶血症,经短期保守治疗控制。黄疸有效缓解率为100%(8/8);平均随访6.5个月(4~9个月),有2例患者在治疗后4.5个月左右再次出现黄疸,同时合并十二指肠降部梗阻,内镜无法通过,行剖腹胆肠、胃肠内引流术;其余患者支架均保持通畅。结论对于无法手术切除的胆道恶性梗阻患者,采用经内镜射频消融联合支架置入治疗是安全可行的,且近期疗效满意。     

内镜下胆管腔内射频消融治疗胆道恶性梗阻患者的护理

目的总结内镜下逆行胰胆管造影(ERCP)联合胆管腔内射频消融治疗胆道恶性梗阻的护理经验。方法对50例不宜外科手术切除的胆道恶性梗阻患者实施腔内射频消融治疗,并进行护理评估、心理干预、病情观察、症状管理及精心护理等。结果 50例均完成胆管内射频消融治疗并留置胆道支架或行胆道外引流术。术后共9例患者发生并发症,其中3例急性胆管炎、5例急性胰腺炎、1例切缘出血,均给予对症治疗后控制。随访0.5~6个月,5例支架堵塞,均行内镜下支架更换后引流通畅,1例死于心脑血管意外,其余患者无特殊不适。结论系统的术前护理评估及专科护理能有效降低术后并发症的发生。     

胆道支架介入治疗恶性胆道梗阻136例临床分析

目的探讨胆道支架(金属支架、塑料支架)介入治疗恶性胆道梗阻的应用价值。方法2005年8月～2008年5月,对136例不宜行手术治疗的恶性胆道梗阻患者,通过内镜途径或经皮经肝途径行胆道支架置入术。结果内镜成功128例,不成功的8例行经皮经肝穿刺。放置金属支架71例,塑料支架65例。放置胆道内支架1周后,血清总胆红素、ALT、AST均明显下降(P0.01),临床症状显著改善。71例放置胆道金属支架者中,11例术后2个月内支架阻塞,再次放置塑料支架后引流通畅;余60例支架通畅时间270～286d,平均275d。65例放置塑料内支架者中,9例术后1～4周支架移位和梗阻,重新置入塑料支架;余56例支架通畅时间110～128d,平均118d。经皮经肝途径术后发生胆汁性腹膜炎1例,经保守治疗治愈。其余病例无严重并发症。随访生存时间1.5～28个月,存活3个月以上者92例。结论胆道支架介入治疗恶性胆道梗阻疗效确切,适用于不宜手术者,对于解除晚期恶性胆道梗阻性黄疸、缓解症状、提高患者生存质量具有满意效果。估计生存期3个月者,宜选择金属支架;估计生存期3个月或经济条件不充许者,可选用塑料支架。     

胆道支架植入加介入化疗方法治疗高位恶性胆道梗阻的体会

目的:评估胆道支架植入结合介入化疗在高位恶性胆道梗阻病人中的疗效。方法:对49例植入胆道支架并辅以选择性动脉插管化疗的病人,回顾性分析血清总胆红素(SB)和碱性磷酸酶(AKP)的变化,及支架阻塞发生率和存活时间。结果:术后2周,血清总胆红素和碱性磷酸酶水平较术前明显下降。在39例植入(33.3%)可膨式金属支架病人中,13例(33.3%)发生阻塞,中位阻塞时间为10个月;10例塑料支架均在术后4个月内出现阻塞。本组病人的中位生存时间为12个月,1年生存率为55%,2年生存率为20%。结论:对高位恶性胆道梗阻病人,植入胆道支架同时辅以选择性动脉化疗是合适的治疗方法。可膨式金属支架较塑料支架的效果更好。     

基于倾向性评分法探讨胆道腔内射频消融联合支架置入术治疗恶性胆道梗阻的临床疗效

目的探讨胆道腔内射频消融(radiofrequency ablation, RFA)联合支架置入术治疗恶性胆道梗阻的临床疗效。方法选取2013年1月至2016年6月我院收治的63例恶性胆道梗阻患者,其中24例行胆道腔内RFA联合支架置入术(射频组), 39例行单纯胆道支架置入术(支架组)。利用倾向性评分匹配法,消除组间协变量的差异,比较两组患者术后胆红素的变化及随访情况。结果共19对匹配成功。两组患者术后7 d和14 d的总胆红素(total bilirubin, TBil)、直接胆红素(direct bilirubin, DBil)水平较各组术前均明显下降,差异有统计学意义(P0.05)。两组患者术后7 d和14 d的TBil、DBil水平、并发症发生率比较,差异均无统计学意义(P0.05)。射频组术后3、6及12个月的支架通畅率和生存率在数值上均高于支架组,但仅术后6个月的支架通畅率比较(63.16%vs. 26.9%),两组差异有统计学意义(P0.05)。射频组术后总生存期长于支架组(11个月vs. 7.4个月),差异有统计学意义(P0.05)。结论胆道腔内射频消融联合支架置入术治疗恶性胆道梗阻安全有效,较单纯支架置入术,可以延缓胆道再次狭窄,延长生存时间。     

经皮肝胆道金属支架治疗肝门部胆道恶性梗阻

目的 探讨经皮肝穿刺胆道造影(percutaneous transhepatic cholangiography,PTC)途径胆道金属支架治疗ERCP失败或不能耐受ERCP的肝门部恶性胆管梗阻患者的疗效和相关并发症.方法 回顾分析此类患者48例的临床资料和随访资料.结果 48例中支架置放成功46例,成功率98%;2周后退黄显效37例,有效7例,有效率95.5%;支架通畅时间6~33周,平均(21.3±8.6)周;术后腹腔内出血2例,胆漏2例,气胸1例,术后感染3例经对症处理后好转.结论 经PTC途径胆道金属支架置入术操作成功率高,安全有效,可有效地保持胆道引流通畅,减轻黄疸,改善患者生活质量,延长患者生命.     

胆道支架置入联合介入化疗治疗恶性胆道梗阻的临床疗效分析

目的探讨胆道支架置入联合介入化疗技术治疗恶性胆道梗阻的临床疗效和价值。方法对比分析胆道支架置入联合介入化疗组(C组)、单纯胆道支架置入组(B组)及保守治疗组(A组)患者间的术前、术后肝功能改变,并发症发生率,支架通畅率及远期生存时间。结果共纳入病例58例,同A组相比,B、C组肝功能得到明显改善,差异有统计学意义(P0.05);B、C两组与操作有关的并发症发生率为19.1%(9/47),均经保守治疗后恢复,无严重并发症发生;B组术后第3、6、12月时支架通畅率分别为77.8%(14/18)、38.9%(7/18)、11.1%(2/18);C组术后第3、6、12月支架通畅率分别为85%(17/20)、55%(11/20)、30%(6/20);A组、B组及C组的中位生存期分别为2.4、8.2及12.9个月。结论胆道支架置入联合介入化疗技术治疗恶性胆道梗阻切实可行,安全有效,能显著改善肝功能,延长支架通畅时间,延长患者远期生存时间。     

胆道恶性梗阻患者内镜射频消融治疗术后发生并发症的影响因素分析

目的分析内镜射频消融治疗胆道恶性梗阻患者术后发生并发症的影响因素。方法回顾分析2010年1月至2021年6月在浙江大学医学院附属杭州市第一人民医院消化内科接受内镜射频消融治疗的110例胆道恶性梗阻患者资料, 其中男性62例, 女性48例, 年龄(74.1±11.1)岁。依据术后是否发生并发症分为并发症组(n=18)和对照组(n=92)。单因素和多因素logistic回归分析并发症影响因素。结果 110例胆道恶性梗阻患者均顺利完成射频消融, 技术成功率为100.0%(110/110)。术后发生并发症18例(16.4%), 其中胆道感染12例(急性胆管炎8例, 急性胆囊炎4例), 急性胰腺炎6例, 均经治疗后治愈。并发症组合并糖尿病、胆管狭窄长度>2.5 cm、分段射频消融狭窄胆管、置入单根支架比例均高于对照组, 差异均有统计学意义(均P<0.05)。多因素logistic回归分析, 合并糖尿病(OR=6.967, 95%CI:1.256～38.658)、分段射频消融狭窄胆管(OR=8.297, 95%CI:1.526～45.122)的胆道恶性梗阻患者内镜射频消融术后发生并发症...     

射频消融术可改善恶性胆道狭窄患者的支架通畅性及生存率

正【据《Gastrointest Endosc》2017年11月报道】题:射频消融术联合胆道支架植入对比单独支架植入治疗恶性胆道狭窄的系统综述和Meta分析(作者Sofi AA等)。不可切除的恶性胆管狭窄通常由姑息性支架植入胆管树进行胆汁引流。近些年,射频消融(radiofrequency ablation,RFA)已被用于改善这些患者胆道支架的通畅性。相关研究评估了RFA联合胆道支架植入在支架通畅率和患者生存率方     

Feasibility and safety of percutaneous transhepatic endobiliary radiofrequency ablation as an adjunct to biliary stenting in malignant biliary obstruction

Purpose

The purpose of this study was to investigate the feasibility and safety of percutaneous transhepatic endobiliary radiofrequency ablation (RFA) combined with biliary stenting in palliative treatment of malignant biliary obstructions.

Adjuvant therapies using biliary stenting for malignant biliary obstruction

The aim of this study was to analyze the patency of expandable metallic stents in malignant biliary obstruction and to evaluate the efficacy of adjuvant therapy accompanied by biliary stenting. We analyzed 29 patients in whom bile duct stenting was performed for malignant biliary obstruction. Their types of disease were: hilar ductal carcinoma (n = 8), gallbladder carcinoma (n = 11), and pancreatic carcinoma (n = 10). Initially, 46 expandable metallic stents were placed in 29 patients. In 23 of the 29 patients, adjuvant therapy was administered. Seventeen patients underwent radiotherapy, and 16 patients received various systemic chemotherapies. In principle, hyperthermia was performed twice a week, simultaneously with radiotherapy. Patient survival and the probability of stent patency were calculated using actuarial life table analysis. There was no significant difference in stent patency among the patients according to type of disease. Hyperthermia did not influence the stent patency rate. The median stent patency time was significantly greater in the chemo-radiation group than in the no-adjuvant therapy group: 182 days versus 68 days, respectively (P = 0.017). Moreover, a significant increase was seen in the median survival time in the chemo-radiation group: 261 days versus 109 days (P = 0.0337). Complications occurred in 9 patients (31.0%). Stent occlusion occurred in 6 patients (20.7%), with all of these patients managed successfully using a transhepatically placed new expandable metallic stent, employing the stent-in-stent method. Stent migration occurred in 2 patients after radiotherapy. Adjuvant therapies such as radiotherapy and systemic chemotherapy, in combination with stent insertion, resulted in an increase in the patency period of expandable metallic stents and in increased patient survival time. Received: August 18, 2000 / Accepted: December 1, 2000     

Systematic appraisal of the role of metallic endobiliary stents in the treatment of benign bile duct stricture

OBJECTIVE: To carry out a systematic appraisal of the current status of the use of metallic endobiliary stents in the treatment of benign biliary strictures. METHODS: A computerized search of the MEDLINE and EMBASE databases identified 37 studies providing detailed clinical course data on outcome of metallic endobiliary stent placement in 400 patients. Pooled data were examined for etiology of stricture, indications for stent placement, procedure-related complications, and outcome with reference to stent patency. RESULTS: The median (range) number of patients per report was 8 (2-54) with a median recruitment period of 44 (9-126) months. The most frequent indications were postoperative biliary strictures in 123 (31%), stenosed biliary-enteric anastomoses in 79 (20%), and biliary strictures following liver transplantation in 88 (22%). During a median follow up of 31 (1-111) months, 139 (35%) stents occluded, and there are little patency data beyond 2 years after deployment, with 99 (25%) known to be patent at 3 years from stent placement. CONCLUSIONS: These pooled data on 400 patients constitute the largest collective report to date on the use of metallic endobiliary stents for benign biliary strictures. The results show a critical lack of data on long-term patency such that at the present time, metallic endobiliary stents should not be used for benign stricture in those patients with a predicted life expectancy greater than 2 years.     

胆道、十二指肠支架置入治疗胆道合并十二指肠恶性梗阻

目的探讨胆道支架、十二指肠支架置入治疗胆道合并十二指肠恶性梗阻的临床价值。方法2008年1月～2013年12月,对24例同时存在胆道和十二指肠恶性梗阻的患者完成胆道支架、十二指肠支架置入,其中介入中心10例患者行经皮肝穿刺造影完成胆道金属支架置入（percutaneoustranshepaticinsertionofbiliarystent,PTIBS）,14例消化内镜中心患者行逆行胰胆管造影放置胆道金属支架（endoscopicretrogradecholangiopancreatography—guidedbiliarystent,ERCP．BS）,其中1例失败后改行经皮肝穿刺胆管外引流术不纳入随访研究。胆管支架置入术后1周完成十二指肠支架置入。观察手术成功率、临床症状缓解率、并发症、支架通畅时间及患者生存期等指标。结果联合支架置入成功率95．8％（23／24）,梗阻症状消失率87．0％（20／23）;十二指肠支架置入术后1周胃出口梗阻评分（2分6例,3分17例）较术前（O分6例,1分17例）明显改善（Z=-4．796,P=0．000）。胆道支架通畅时间（73．9±5．3）d,生存时间（93．0±4．9）d。十二指肠支架再发梗阻率17．4％（4／23）。均未出现严重并发症。结论胆道、十二指肠支架联合置入治疗恶性胆道、十二指肠梗阻安全有效。     

胆道支架技术5年回顾(213例随访报告)

目的 评价胆道支架技术对恶性胆道梗阻的应用价值，该技术5年来的创新及联合抗肿瘤治疗的意义。方法 213例胆道恶性梗阻病人，采用经皮经肝胆道造影及支架植入术。104例支架植入后并用抗肿瘤治疗。结果 单支架植入142例，双支架植入68例。支架植入成功率98．6％。黄疸完全解除率84．8％，总有效率95．9％。支架并抗肿瘤治疗89例与单纯支架植入51例1年生存率分别为48．3％和17．6％，χ^2=11.22,P=0.01；两年生存率为14．6％和5．9％，χ^2=3．01，P＝0．10。支架再阻塞52例，40例给予动脉化疗栓塞、经皮穿刺外引流或支架内支架治疗，黄疸再度消退。结论 （1）胆道支架植入技术成功率高，减黄疗效确切。（2）应用介入方法可实现梗阻胆管的充分引流和处理支架再狭窄。（2）支架植入联合抗肿瘤治疗可提高病人生存率。     

高位胆道恶性梗阻介入治疗

目的 探讨肝管汇合处恶性梗阻经皮肝穿刺内支架置入操作难点与对策.方法 对23例高位胆道恶性梗阻病人采用经皮肝穿刺胆道支架置放及内外引流术(PTBD).分别观察介入成功率,并发症发生率,血清胆红素下降情况,随访胆道支架维持通畅时间和病人生存期.结果 23例首次介入成功22例,占95.65%;21例总胆红素明显下降(下降百分比>60%),2例无效(下降百分比<10%);谷丙转氨酶(GPT)和谷草转氨酶(GOT)明显下降,平均18 d恢复正常.术后发热2例(38℃),胆道出血1例,右上腹部疼痛6例,穿刺点周围局限性腹膜炎1例,GPT升高3例,经止血抗炎护肝对症治疗后2～5 d后症状消失;引流管滑脱1例;无大出血、胆汁瘘等严重并发症.全组平均生存期8.5个月.结论 肝管汇合处恶性梗阻支架置放操作难度大,导丝通过梗阻段是关键,正确掌握操作方法町显著提高手术成功率.     

超声引导经皮经肝支架置入在胆道恶性梗阻中的应用

目的探讨超声引导经皮经肝支架置入技术在胆道恶性梗阻中的治疗意义。方法16例恶性胆道梗阻患者,采用B超引导经皮经肝胆管穿刺置管外引流,并胆道造影后行金属支架置入。结果胆道支架置入成功率100%,2例术后分别出现胆道及腹腔内出血,保守治疗控制。术后1~4周黄疸消除率87.5%。最短生存时间2个月,最长18个月,中位生存时间6.8个月。6例随访期间出现胆道再梗阻,其中3例经B超引导经皮经肝胆道(PTCD)外引流 胆道冲洗再通,另3例因肿瘤长入,长期PTCD外引流。结论(1)胆道金属支架减黄效果确切,并能原位恢复胆道的生理连续性;(2)超声介导技术可提高胆道金属支架置入成功率;(3)充分有效的胆汁外引流能减少支架置入的相关并发症,也为胆道再梗阻提出了解决的途径。     

Unresectable Malignant Biliary Obstruction: Treatment by Self-Expandable Biliary Endoprostheses

The primary goal in the treatment of malignant obstruction is the relief of jaundice. Although operative biliary bypass is a reliable method of palliation, nonoperative palliation may be desirable in selected patients.We report our experience with forty-eight self expandable metallic biliary endoprostheses (Wallstent) percutaneously placed in 35 patients with irresectable malignant biliary obstruction. In twelve patients more than one stent was necessary to bridge the entire length of the biliary stenosis. The obstruction was due to primary tumors in 14 and to lymph node metastases in 12. In nine patients transanastomotic stents were placed after previous bilioenteric anastomosis because of malignant obstruction. Complications occurred in 11 patients (31.4%), and five patients died within 30 days of stent placement (14.3%). The mean stent patency to date of patients discharged is 6.1 months, and the mean survival 7.2 months. Follow up data is available for 29 patients, and excellent palliation was achieved for more than 75% of the survival time in 22 (76%). Seven patients have had documented stent occlusion requiring further intervention (24%).In this selected group of patients, the results of percutaneous self-expandable stents are encouraging. However, our data does not support the initial reports of self-expandable endoprostheses that suggest an improved result compared to conventional plastic stents. A randomized study using either expandable stents as compared to operative biliary enteric bypass is necessary.