CAJ | 학술논문

目的：探讨经皮肝穿刺胆道腔内射频消融技术姑息性治疗恶性梗阻性黄疸的安全性及可行性。方法选取2013年1月－2014年3月接受治疗的20例无法切除的恶性梗阻性黄疸患者作为实验组，其中9例不能外科手术切除患者透视下行经皮肝穿刺胆道腔内射频消融术，并留置金属胆道支架；同期随机纳入11例相似病情患者作为对照组，经皮肝穿刺胆道造影（PTC）成功后仅行胆道支架置入。观察两组手术并发症及黄疸缓解情况，密切随访并比较术后3和6个月支架的通畅性。结果所有患者术后通过门诊或电话均获得完整随访。实验组及对照组术后3个月支架通畅率分别为100％，72．7％（χ2＝2．888，P ＝0．218），术后6个月支架通畅率分别为：87．5％、27．3％（χ2＝6．739，P ＝0．02）。随访期内射频组1例患者于术后113 d 死于消化道出血，对照组1例患者于57 d 死于肝功能衰竭，1例患者于术后142 d 死于弥散性血管内凝血。结论经皮肝穿刺胆道腔内射频消融对恶性胆道梗阻的治疗是安全和可行的，在延长自膨式金属支架通畅性方面初步疗效令人满意，但尚需大量样本随机对照研究进一步验证。
목적：탐토경피간천자담도강내사빈소융기술고식성치료악성경조성황달적안전성급가행성。방법선취2013년1월－2014년3월접수치료적20례무법절제적악성경조성황달환자작위실험조，기중9례불능외과수술절제환자투시하행경피간천자담도강내사빈소융술，병류치금속담도지가；동기수궤납입11례상사병정환자작위대조조，경피간천자담도조영（PTC）성공후부행담도지가치입。관찰량조수술병발증급황달완해정황，밀절수방병비교술후3화6개월지가적통창성。결과소유환자술후통과문진혹전화균획득완정수방。실험조급대조조술후3개월지가통창솔분별위100％，72．7％（χ2＝2．888，P ＝0．218），술후6개월지가통창솔분별위：87．5％、27．3％（χ2＝6．739，P ＝0．02）。수방기내사빈조1례환자우술후113 d 사우소화도출혈，대조조1례환자우57 d 사우간공능쇠갈，1례환자우술후142 d 사우미산성혈관내응혈。결론경피간천자담도강내사빈소융대악성담도경조적치료시안전화가행적，재연장자팽식금속지가통창성방면초보료효령인만의，단상수대량양본수궤대조연구진일보험증。
Objective To investigate the safety and feasibility of percutaneous intraductal radiofrequency ablation (palliative therapy)in the treatment of malignant obstructive jaundice.Methods This study included 20 patients with unresectable malignant obstructive jaundice, who were treated in the First Affiliated Hospital of Zhengzhou University from January 2013 to March 2014.Nine of them (test group)under-went percutaneous intraductal radiofrequency ablation plus metallic biliary stent placement.The other 11 similar cases (control group)un-derwent metallic biliary stent placement alone after successful percutaneous transhepatic cholangiography.Operative complications and remis-sion of jaundice were observed,and the stent patency after at 3 and 6 months after operation was evaluated and compared between the two groups.Results All patients were followed completely by outpatient or telephone.The stent patency rate at 3 months after operation was 9 /9 in the test group and 8 /11 in the control group (χ2 =2.888,P =0.218),and the stent patency rates at 6 months were 7 /8 and 3 /11,re-spectively (χ2 =6.739,P =0.02).During follow -up,one case in the test group died of gastrointestinal bleeding at 113 d after operation;one case in the control group died of liver failure at 57 d after operation and one case died of disseminated intravascular coagulation at 142 d. Conclusion Percutaneous intraductal radiofrequency ablation is safe and feasible in the treatment of malignant biliary obstruction,and the preliminary efficacy in prolonging the patency of self -expanding metallic stent is satisfactory.However,this therapy needs to be further ver-ified via large -sample randomized controlled studies.