经皮胆道射频消融术在治疗恶性胆道梗阻中的应用

目的分析经皮肝穿刺射频消融联合支架植入治疗恶性胆道梗阻的有效性、安全性。方法 33例恶性胆道梗阻患者接受胆道射频消融联合胆道金属支架植入治疗,评价术后1、2、3个月支架通畅率和患者的生存率。结果对33例患者均完成胆道射频消融联合胆道金属支架植入治疗。术后患者肝功能均得到不同程度的恢复。随访期内,中位支架通畅时间103天(9~578天)。术后1、2、3个月支架通畅率分别为78.79%(26/33)、66.67%(22/33)、54.55%(18/33)。随访期内,28例患者死亡,中位生存时间193天(19~578天)。患者术后1、2、3个月生存率分别为96.97%(32/33)、81.82%(27/33)、75.76%(25/33)。9例患者术后出现胆道感染,其中1例严重肝病患者死于胆道感染引起的感染性休克,8例患者恢复;13例患者出现无症状淀粉酶升高。所有患者均未出现胆道出血、穿孔等严重并发症。结论经皮肝穿刺射频消融联合金属支架植入治疗恶性胆道梗阻具有较高的安全性和有效性。

Application of percutaneous endobiliary radiofrequency ablation for treatment of malignant biliary obstruction

Objective To explore the effectiveness and safety of endobiliary radiofrequency ablation combined with metallic stent placement treatment for malignant biliary obstruction. Methods Thirty-three patients with malignant biliary obstruction received endobiliary radiofrequency ablation combined with metallic stent placement treatment, with the survival rate and stent patency rate 1, 2, 3 months after operation being evaluated. Results The endobiliary radiofrequency ablation combined with metallic biliary stent placement operation were accomplished for all 33 patients. The liver function of patients recovered to varying degrees. In the follow-up period, the median patency time of the biliary stent was 103 days (9-578 days). The post-operation stent patency rate at 1, 2, 3 months was 78.79% (26/33), 66.67% (22/33), 54.55% (18/33) respectively. In the follow-up period, 28 patients died; the median survival time was 193 day (19-578 days). The post-operation survival rate at 1, 2, 3 months was 96.97% (32/33), 81.82% (27/33), 75.76% (25/33), respectively. Nine patients suffered from biliary infection: One patient with serious liver disease died of septic shock caused by biliary infection, and 8 patients recovered. Asymptomatic amylase elevation was founded in 13 patients. Serious complications, such as biliary bleeding, perforation etc, were not observed in all patients. Conclusion Percutaneous endobiliary radiofrequency ablation combined with metallic stent placement is effective and safe for malignant biliary obstruction.