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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(P<0.01),支架组治疗前、治疗后7~14 d TB和DB的变化有显著性意义(P<0.01),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。
Objective To compare the efficacy of percutaneous transhepatic biliary tract radiofrequency ablation combined with stent implantation and percutaneous transhepatic biliary stent implantation in the treatment of malignant obstructive jaundice. Methods A retrospective analysis of 56 cases of malignant obstructive jaundice and surgical incision in the Affiliated Hospital of Academy of Military Medical Sciences and 309 Hospital of Chinese PLA from April 2011 to September 2014 was retrospectively analyzed. Among them, 25 cases underwent percutaneous transhepatic bile duct radiofrequency catheter ablation Thirty-one cases underwent percutaneous transhepatic biliary stent implantation (stent group). The levels of total bilirubin (TB) and direct bilirubin (DB) in serum of 7-14 days before and after treatment were observed. Comparisons were made between the overall complication and the median survival time of the stent. Follow-up calls or follow-up data from patient review records. Results The success rate of surgery were 100%, no postoperative peritonitis, perforation and other fatal complications. Three patients in radiofrequency group and 3 patients in stenting group had cholangitis, which was relieved after active medical conservative treatment. The changes of TB and DB in the radiofrequency group before and after treatment were significant (P <0.01), and the changes of TB and DB in the stent group before and 7 to 14 days after treatment were significant (P <0.01) ), However, TB decreased (149.05 ± 110.71) μmol / L and DB decreased (96.93 ± 69.12) μmol / L after radiotherapy for 7-14 days in the radiofrequency ablation group (151.40 ± 94.47 and 94.21 ± 67.36) μmol / L, no significant difference was found between TB and DB in the two groups. The median duration of stent placement was 122 (9-550) and 157 (16-510) days, respectively, with median survival of 125 (9-550) and 163 (16-520) d, respectively, with significant differences between the two groups No significant significance. Conclusions The combination of intracavitary radiofrequency ablation and stent implantation is an effective and safe method for the treatment of unresectable malignant obstructive jaundice. There is no significant difference between the two groups in short-term and long-term efficacy.