射频消融在胆道恶性梗阻金属支架术后再梗阻中的临床应用-现代医学

射频消融在胆道恶性梗阻金属支架术后再梗阻中的临床应用

单位：1. 江苏大学附属人民医院消化内科, 江苏镇江 212002;
2. 东南大学附属中大医院消化内科, 江苏南京 210009;
3. 江苏大学附属人民医院呼吸内科, 江苏镇江 212002

分类号：R657.43

出版年·卷·期（页码）：2018·46·第五期（529-532）

摘要：

目的：探讨经十二指肠镜胆道射频消融术（radiofrequency ablation，RFA）在治疗胆道恶性梗阻内镜下胆道金属支架引流术（endoscopic biliary metallic stent drainage，EBMSD）术后再梗阻中的临床有效性和安全性。方法：通过回顾性分析2014年5月至2016年7月临床确诊的失去手术机会或不愿手术的晚期胆道恶性梗阻放置胆道金属支架后再梗阻的病例，经十二指肠镜行胆道RFA，统计分析术后黄疸消退情况、胆道通畅时间及术后并发症的发生率。结果：胆道恶性梗阻EBMSD后再梗阻患者均顺利完成胆道腔内射频消融术，行RFA治疗后胆道平均通畅时间154 d （26~432 d），30 d通畅率为80%（8/10），60 d通畅率为60%（6/10），90 d通畅率为50%（5/10）。RFA术中仅1例患者出现腹痛，血尿淀粉酶正常，术后第1天患者腹痛自行缓解。无术后胰腺炎、穿孔、出血等并发症。所有患者均在RFA术后1周内碱性磷酸酶（ALP）和γ-谷氨酰转移酶（GGT）明显下降（分别是t=4.884，P=0.001；t=10.633，P=0.000），血清总胆红素下降（t=2.772，P=0.022）。结论：对于晚期胆道恶性梗阻放置金属支架后再梗阻的患者，RFA是一种有效且安全的治疗方法。

Objective: To investigate the clinical efficacy and safety of intraductal radiofrequency ablation (RFA) by duodenoscope in the treatment of malignant biliary obstruction after endoscopic biliary metallic stent drainage (EBMSD).Methods: A retrospective analysis was made for the cases of malignant biliary obstruction after EBMSD which had lost the chance of surgery or unwillingness for the operation in our hospital from May 2014 to July 2016.The treatment of RFA was taken by duodenoscope, and the data of the postoperative jaundice level, the time of biliary tract patency and the complications were collected and analyzed.Results: RFA was successfully performed in all patients and the mean time of patency was 154 days(26-432 days).The patency rate at 30 days was 80% (8/10), the patency rate was 60% (6/10) at 60 days, and the patency rate was 50% (5/10) at 90 days. Only one patient had the complication of abdominal pain in operation with normal level of serum and urinary amylase, and the pain relieved on the first day after operation. There were not the complications of postoperative pancreatitis, perforation and hemorrhage. All patients had a significant decrease of the level of ALP(t=4.884,P=0. 001),GGT(t=10.633,P=0.000) and jaundice(t=4.844,P=0.001) within one week after RFA.Conclusion: RFA is an effective and safe treatment for patients with malignant biliary obstruction after EBMSD.

参考文献：

[1] ALMADI M A,BARKUN J S,BARKUN A N.Stenting in malignant biliary obstruction[J].Gastrointest Endosc Clin N Am,2015,25(4):691-711.
[2] ITOI T,SOFUNI A,ITOKAWA F,et al.Current status and issues regarding biliary stenting in unresectable biliary obstruction[J].Dig Endosc,2013,25(2):63-70.
[3] ISAYAMA H,NAKAY Y,KOGURE H,et al.Biliary self-expandable metallic stent for unresectable malignant distal biliary obstruction:which is better:covered or uncovered?[J].Dig Endosc,2013,25(2):71-74.
[4] SAWAS T,al HALABI S,PARSI M A,et al.Self-expandable metal stents versus plastic stents for malignant biliary obstruction:a meta-analysis[J].Gastrointest Endosc,2015,82(2):256-267.
[5] DUMONCEAU J M,TRINGALI A,BLERO D,et al.Biliary stenting:indications,choice of stents and results:European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline[J].Endoscopy,2012,44(3):277-298.
[6] DAVILA M L,HOFSTETTER W L.Endoscopic management of Barrett's esophagus with high-grade dysplasia and early-stage esophageal adenocarcinoma[J].Thorac Surg Clin,2013,23(4):479-489.
[7] BABA Y,WATANABE M,YOSHIDA N,et al.Radiofrequency ablation for pulmonary metastases from gastrointestinal cancers[J].Ann Thorac Cardiovasc Surg,2014,20(2):99-105.
[8] SONG T J,SEO D W,LAKHTAKIA S,et al.Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer[J].Gastrointest Endosc,2016,83(2):440-443.
[9] ITO N,PFEFFER J,ISFORT P,et al.Bipolar radiofrequency ablation:development of a new expandable device[J].Cardiovasc Intervent Radiol,2014,37(3):770-776.
[10] ZACHAROULIS D,LAZIYRA O,SIOKA E,et al.Habib EndoHPB:a novel endobiliary radiofrequency ablation device.An experimental study[J].J Invest Surg,2013,26(1):6-10.
[11] ALIS H,SENGOZ C,GONENC M,et al.Endobiliary radio-frequency ablation for malignant biliary obstruction[J].Hepato biliary Pancreat Dis Int,2013,12(4):423-427.
[12] 夏宁,程永德,王忠敏.胆道支架再狭窄的介入治疗进展[J].介入放射学杂志,2014,23(1):82-85.
[13] KADAYIFCI A,ATAR M,FORCIONE D G,et al.Radiofrequen-cy ablation for the management of occluded biliary metal stents[J].Endoscopy,2016,48(12):1096-1101.
[14] 何国林,徐小平,周陈杰,等.一种恶性梗阻性黄疸介入治疗的新方法——经皮肝穿刺胆道内射频消融内支架置入术[J].南方医科大学学报,2011,31(4):721-723.
[15] MIZANDARI M,PAI M,XI F,et al.Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction:feasibility and early results[J].Cardiovasc Intervent Radiol,2013,36(3):814-819.
[16] PAI M,VALEK V,TOMAS A,et al.Pereutaneous intraductal radiofrequency ablation for clearance of occluded metal stent in malignant biliary obstruction:feasibility and early results[J].Cardiovasc Intervent Radiol,2014,37(1):235-240.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录