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目的探讨胆道支架引流联合腔内射频消融治疗胆道恶性梗阻的安全性及临床疗效。方法前瞻性纳入18例因胆道恶性梗阻接受内镜逆行胆胰管造影(ERCP)治疗的患者,在胆管插管成功后,循导丝插入双极射频电极,于肿瘤部位进行射频消融,并留置胆道支架进行引流,观察治疗的安全性及临床疗效。结果所有患者均成功接受射频消融治疗;胆道引流成功率为100%(18/18),12例患者留置塑料支架,6例患者留置金属支架,其中3例患者同期留置胰管支架;术后患者出现胆管炎2例,胰腺炎2例,均经短期对症治疗后控制;黄疸明显缓解率为61%(11/18);中位随访期10.9(2.0～15.4)个月,3个月内支架通畅率为87%(13/15),6个月内支架通畅率为64%(9/14),12个月内支架通畅率为25%(2/8);6个月生存率为67%(8/12),12个月生存率为50%(4/8)。结论对于胆道恶性梗阻,胆道支架引流联合腔内射频消融治疗是安全可行的。
Objective To investigate the safety and clinical efficacy of biliary stent drainage combined with radiofrequency catheter ablation in the treatment of malignant biliary obstruction. Methods 18 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) due to malignant biliary obstruction were prospectively enrolled. After successful biliary catheterization, the guide wire was inserted into the bipolar radiofrequency electrode and radiofrequency ablation was performed at the tumor site. Biliary stent drainage, observation of the safety of treatment and clinical efficacy. Results All patients were successfully treated with radiofrequency catheter ablation. The successful rate of biliary drainage was 100% (18/18), plastic stent was placed in 12 patients, metal stent was placed in 6 patients, and 3 patients with pancreatic duct stent placement in the same period. Postoperative patients Two cases of cholangitis and two cases of pancreatitis were treated with short-term symptomatic treatment. The significant response rate of jaundice was 61% (11/18). The median follow-up period was 10.9 (2.0-15.4) months. Stent The patency rate was 87% (13/15). The patency rate was 64% (9/14) in 6 months. The patency rate was 25% (2/8) in 12 months. The 6-month survival rate was 67 % (8/12), 12 months survival rate was 50% (4/8). Conclusions For biliary malignant obstruction, biliary stent drainage combined with intracavitary radiofrequency ablation is safe and feasible.