ERCP引导下腔内射频消融联合支架置入治疗恶性胆管肿瘤合并梗阻的临床疗效及短期预后分析

目的 分析经内镜逆行性胰胆管造影术(ERCP)引导下腔内射频消融联合支架置入治疗恶性胆管肿瘤合并梗阻的临床疗效及短期预后.方法 回顾性分析2013年4月—2016年1月就诊治疗的90例恶性胆管肿瘤合并梗阻患者的临床资料,根据治疗方式的不同分为观察组和对照组,每组45例.观察组采用ERCP引导下腔内射频消融联合支架置入治疗,对照组采用ERCP引导下支架置入治疗.比较并分析两组的临床疗效、随访预后情况及术后并发症情况.结果 治疗后,两组血清总胆红素、γ-谷氨酰转肽酶和碱性磷酸酶均低于治疗前(P<0.01),且观察组低于对照组(P<0.01).观察组胆道通畅时间、生存时间、12个月存活率、黄疸有效缓解率均明显多于或高于对照组(P<0.01).两组术后1个月并发症总发生率比较差异无统计学意义(P>0.05).结论 ERCP引导下腔内射频消融联合支架置入治疗恶性胆管肿瘤合并梗阻,可显著的改善黄疸及肝功能情况,且可有效的延长胆道通畅时间及生存时间,可作为临床治疗恶性胆管肿瘤合并梗阻的优选治疗方式.

Clinical Efficacy and Short-term Prognosis of ERCP-guided Intracavitary Radiofrequency Ablation Combined with Stent Implantation in Treatment of Malignant Bile Duct Tumor Associated by Obstruction

Objective To analyze clinical efficacy and short-term prognosis of endoscopic retrograde cholangio-pancreatography ( ERCP)-guided intracavitary radiofrequency ablation ( RFA) combined with stent implantation in treat-ment of malignant bile duct tumor associated by obstruction. Methods Clinical data of 90 patients with malignant bile duct tumor associated by obstruction admitted during April 2013 and January 2016 was retrospectively analyzed, and the patients were divided into observation group and control group ( n=45 for each group) according to different treatment methods. Observation group was treated with ERCP-guided intracavitary RFA combined with stent implantation, while control group was treated with ERCP-guided stent implantation. Clinical effects were compared and analyzed, and condi-tions of prognosis and postoperative complications were followed up. Results After treatment, serum total bilirubin,γ-glutamyl transpeptidase and alkaline phosphatase levels were significantly decreased than those before treatment in two groups (P<0. 01), and the levels in observation group were significantly lower than those in control group (P<0. 01). Values of biliary tract smooth time, survival time, 12 months of survival rate and jaundice effective remission rate in ob-servation group were significantly higher than those in control group ( P<0. 01 ) . There was no significant difference in the total incidence rate of complications in postoperative 1 month between the two groups (P>0. 05). Conclusion ER-CP-guided intracavitary radiofrequency ablation combined with stent implantation in treatment of malignant bile duct tumor associated by obstruction can significantly improve jaundice and liver function, and effectively prolong biliary tract smooth and survival times, and it may be used as a optimized method for treating malignant bile duct tumor associated by obstruc-tion.