经内镜射频消融和置入内支架联合治疗不能切除的胆胰肿瘤

目的探讨经内镜射频消融和置入内支架的联合治疗在延长不能切除的胆胰肿瘤患者胆道通畅期中的作用。方法共58例患者采用联合治疗：6例十二指肠乳头癌先作内镜下乳头局部切除，而后对残留病灶作射频消融；52例经ERCP测出肿瘤狭窄段的范围，对狭窄段作射频消融，然后置入相匹配的金属内支架。收集同期52例单放金属内支架者作为对照组。结果在联合治疗组中，3例治疗后2个月内因胆道严重感染、全身衰竭死亡，余55例胆道平均通畅期为9．2个月，平均存活期为16个月。其中48例再次梗阻后再次内镜下治疗，28例单作射频消融和20例射频消融加再置入内支架，通畅期又平均延长5．1个月。而单放内支架组胆道通畅期为6．1个月，平均存活期为13个月。结论射频消融能阻止肿瘤的局部增长，从而延长内支架的通畅期和患者的存活期。

Treatment of non-resectable pancreaticobiliary malignancy by endoscopic biliary endoprothesis and radiofrequency

Objective To study the therapeutic effect of endoscopic biliary endoprothesis and radio- frequency prolonging the duration of biliary duet patency of patients with non-resectable pancreaticobiliary malignancies. Methods There are 58 patients in combined therapy group; ERCP were done on all patients. Six patients with duodenal papilla cancer were first treated with endoscopic local excision of papilla; then with radiofrequency on residual region. ERCP were performed on 52 patients with malignant biliary obstruction to investigate the locus and extent of the obstruction, and treated with radiofrequency to the stenosed segment, then placed the matched metal stents into the bihary duet. Fifty-two patients installed with the metal biliary duet stent served as controls. Results In combined therapy group, 3 patients died of severe biliary duet infection or functional multi-organ failure within 2 months; biliary duet pateney kept for 9. 2 months on average in 55 patients, the duration of pateney was prolonged 5.1 months in 28 patients treated with radiofrequency twice and 20 patients inserted stent again. The median survival time of all patients was 16 months. In control group, biliary duet patency kept for 6. 1 months, the median survival time was 13 months. Conclusion The combined therapy of endoscopic biliary endoprothesis and radiofrequency is safe and effective. It can prolong the duration of biliary duet patency and survival time, and radiofrequency can possibly prevent the local growth of tumor.