腔内射频消融联合胆道支架植入术和单纯胆道支架植入术治疗恶性梗阻性黄疸的临床效果分析

发布时间：2018-11-22 17:23

【摘要】：目的比较经皮肝穿刺胆道腔内射频消融联合支架植入术和单纯经皮肝穿刺胆道支架植入术治疗恶性梗阻性黄疸的疗效。方法回顾性地分析2011年4月至2014年9月军事医学科学院附属医院和解放军309医院收治的恶性梗阻性黄疸且不能手术切除患者56例,其中25例行经皮肝穿刺胆道腔内射频消融联合支架植入术(射频组),31例行单纯经皮肝穿刺胆道支架植入术(支架组)。观察治疗前后7~14 d血清总胆红素(TB),直接胆红素(DB)的变化,并对全体患者的手术并发症、支架中位通畅期及患者中位生存期进行比较,通过电话随访或从患者复查记录中获取随访数据。结果手术成功率均为100%,术后均未出现腹膜炎、穿孔等致死性并发症。射频组3例患者及支架组3例患者出现胆管炎,经积极内科保守治疗后缓解。射频组治疗前、治疗后7~14 d TB和DB的变化有显著性意义(P0.01),支架组治疗前、治疗后7~14 d TB和DB的变化有显著性意义(P0.01),但7~14 d后射频组TB下降了(149.05±110.71)μmol/L,DB下降了(96.93±69.12)μmol/L;支架组两者分别下降了(151.40±94.47)和(94.21±67.36)μmol/L,两组间TB和DB下降无显著性意义。两组的支架中位通畅期分别为122(9~550)和157(16~510)d,中位生存期分别为125(9~550)和163(16~520)d,两组比较差异无显著性意义。结论腔内射频消融联合支架植入与单纯支架植入均是治疗不能手术切除的恶性梗阻性黄疸有效而安全的方法,两者的近期及远期疗效差异均无明显统计学意义。
[Abstract]:Objective to compare the efficacy of percutaneous radiofrequency catheter ablation (RFCA) combined with stent implantation in the treatment of malignant obstructive jaundice. Methods from April 2011 to September 2014, 56 patients with malignant obstructive jaundice treated in affiliated Hospital of Academy of military Medical Sciences and PLA 309 Hospital were retrospectively analyzed. 25 cases were treated with percutaneous transhepatic radiofrequency ablation (RFCA) combined with stent implantation (radiofrequency group) and 31 cases were treated with percutaneous transhepatic biliary stenting (stenting group). The changes of serum total bilirubin (TB), direct bilirubin (DB) were observed before and 14 days after treatment. The operative complications, the median patency of stents and the median survival time of the patients were compared. Follow-up data were obtained by telephone or from patient review records. Results the successful rate of operation was 100, and no fatal complications such as peritonitis and perforation were found after operation. Cholangitis occurred in radiofrequency group (3 cases) and stent group (3 cases). Before and after treatment, the changes of TB and DB in radiofrequency group were significant (P0.01), and the changes of TB and DB in stenting group were significant before and 7d after treatment (P0.01). However, TB decreased (149.05 卤110.71) 渭 mol/L,DB and (96.93 卤69.12) 渭 mol/L; in radio frequency group 14 days later. There was no significant decrease in TB and DB between the stent group (151.40 卤94.47) and the stent group (94.21 卤67.36) 渭 mol/L,. The median patency period of stents in the two groups was 122 (9 / 550) and 157 (16 / 510) d, respectively, and the median survival time was 125 (9 / 550) and 163 (16 / 520) d, respectively. There was no significant difference between the two groups. Conclusion intracavitary radiofrequency ablation combined with stent implantation and stent implantation alone are effective and safe methods for the treatment of malignant obstructive jaundice which can not be resected. There is no significant difference in the short-term and long-term results between the two groups.
【作者单位】：河北北方学院;军事医学科学院附属医院;
【分类号】：R730.5

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