经内镜腔内射频消融联合胆管支架置入治疗晚期胰腺癌并梗阻性黄疸的临床研究

Clinical study of endoscopic intracavitary radiofrequency ablation combined with biliary stent implantation in treatment of advanced pancreatic cancer complicated with obstructive jaundice

摘要:

目的 探讨经内镜腔内射频消融（RFA）联合胆管支架置入治疗晚期胰腺癌并梗阻性黄疸的安全性和疗效。方法 回顾性分析46例失去手术机会的晚期胰腺癌合并梗阻性黄疸患者的临床资料，比较射频组（n = 16，腔内RFA联合支架置入）和对照组（n = 30，单纯支架置入）术后并发症发生情况、黄疸消退程度、腹痛缓解情况、支架中位通畅时间和中位生存时间。结果 两组患者术后均未出现穿孔、出血、胆漏和胰漏等严重并发症，术后胆管炎和一过性胰腺炎发生率比较，差异均无统计学意义（P > 0.05）。术后1周射频组血清总胆红素（TBIL）和直接胆红素（DBIL）分别为（62.99±42.31）和（50.89±37.78）μmol/L，较术前的（181.51±114.14）和（156.90±105.79）μmol/L明显降低，对照组分别为（112.21±84.27）和（84.23±70.01）μmol/L，较术前的（184.06±130.00）和（160.65±119.93）μmol/L明显降低，射频组黄疸消退程度较对照组更明显（P < 0.05）。两组患者术后1个月视觉模拟评分（VAS）均较术前降低，射频组腹痛缓解有效率为87.5%，明显高于对照组的26.7%（P < 0.05）。射频组患者中位生存时间和支架中位通畅时间分别为296和241 d，均长于对照组的240和188 d（P < 0.05）。结论 对于晚期胰腺癌合并梗阻性黄疸的患者，腔内RFA联合胆管支架较单纯胆管支架置入能够更有效地减黄、缓解癌性疼痛、延长支架通畅期、延长患者生存时间、提高患者生活质量，疗效确切，值得临床进一步推广应用。

Abstract:

Objective To investigate the safety and therapeutic effect of endoscopic intracavitary radiofrequency ablation combined with biliary stent implantation in treatment of advanced stage unresectable pancreatic cancer complicated with obstructive jaundice.Methods The clinical data of 46 patients with advanced pancreatic cancer complicated with obstructive jaundice who lost the opportunity of operation were retrospectively analyzed. The postoperative complications, regression level of jaundice, abdominal pain relief, median stent patency time and median survival time were compared between the radiofrequency group (n = 16, intracavitary radiofrequency ablation combined with stent placement) and the control group (n = 30, simple stent implantation placement).Results No serious complications such as perforation, bleeding, bile and pancreatic leakage occurred in both the two groups. There was no significant difference in the incidence of postoperative cholangitis and transient pancreatitis (P > 0.05). The serum levels of total bilirubin (TBIL) and direct bilirubin (DBIL) were (62.99±42.31) μmol/L and (50.89 ± 37.78) μmol/L in the radiofrequency group one week after operation, compared with the preoperative values of (181.51 ± 114.14) μmol/L and (156.90 ± 105.79) μmol/L, there were significantly decreased; There were (112.21 ± 84.27) μmol/L and (84.23 ± 70.01) μmol/L in the control group, compared with the preoperative values of (184.06 ± 130.00) μmol/L and (160.65 ± 119.93) μmol/L, there were significantly decreased, the degree of jaundice subsidence in radiofrequency group was more significant than that in control group (P < 0.05). The visual analogue scale (VAS) of the two groups one month after operation were lower than that before operation, and the effective rate of abdominal pain relief of radiofrequency group was significantly higher than that of control group (87.5% vs 26.7%, P < 0.05). The median survival time and median patency time of radiofrequency group were higher than those of control group (296 d vs 240 d and 241 d vs 188 d, P < 0.05).Conclusion For patients with advanced unresectable pancreatic cancer complicated with obstructive jaundice, intracavitary radiofrequency ablation combined with biliary stent implantation is more effective than simple stent implantation in reducing jaundice, alleviating patients' pain, prolonging the stent patency time and patients' survival time.