CAJ | 학술논문

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。
목적：비교경피간천자담도강내사빈소융연합지가식입술화단순경피간천자담도지가식입술치료악성경조성황달적료효。방법회고성지분석2011년4월지2014년9월군사의학과학원부속의원화해방군309의원수치적악성경조성황달차불능수술절제환자56례，기중25례행경피간천자담도강내사빈소융연합지가식입술（사빈조），31례행단순경피간천자담도지가식입술（지가조）。관찰치료전후7～14 d혈청총담홍소（TB），직접담홍소（ DB）적변화，병대전체환자적수술병발증、지가중위통창기급환자중위생존기진행비교，통과전화수방혹종환자복사기록중획취수방수거。결과수술성공솔균위100％，술후균미출현복막염、천공등치사성병발증。사빈조3례환자급지가조3례환자출현담관염，경적겁내과보수치료후완해。사빈조치료전、치료후7～14 d TB화DB적변화유현저성의의（P＜0．01），지가조치료전、치료후7～14 d TB화DB적변화유현저성의의（P＜0．01），단7～14 d후사빈조TB하강료（149．05±110．71）μmol／L，DB하강료（96．93±69．12）μmol／L；지가조량자분별하강료（151．40±94．47）화（94．21±67．36）μmol／L，량조간TB화DB하강무현저성의의。량조적지가중위통창기분별위122（9～550）화157（16～510） d，중위생존기분별위125（9～550）화163（16～520） d，량조비교차이무현저성의의。결론강내사빈소융연합지가식입여단순지가식입균시치료불능수술절제적악성경조성황달유효이안전적방법，량자적근기급원기료효차이균무명현통계학의의。
Objective To compare the effect of percutaneous intraluminal radiofrequency ablation ( RFA ) combined with biliary stenting and that of percutaneous transhepatic puncture combined with biliary stenting .Methods A total of 56 patients with unresectable malignant obstructive jaundice were reviewed retrospectively .Among them, 25 patients had received percutaneous intraluminal RFA combined with biliary stenting ( RFA group) while another 31 patients had been simultaneously selected for the simple biliary stent implantation ( stent group ) .The changes of the serum total bilirubin ( TB) and direct bilirubin ( DB) before and after 7-14 days of treatment , surgical complications , stent median patency and the median survival were observed.Follow-up information was obtained through telephone reviews or check-up records. Results The technical success rate was 100%.No procedure-related peritonitis or perforation occurred .There were respectively 3 cases with cholangeitis in RFA group and 3 in stent group.All the cases was controlled by effective clinical treatment.There was obvious statistically significant difference after treatment in TB and DB in the two groups (P<0.01, P<0.01).TB and DB fell by (149.05 ±110.71) and (96.93 ±69.12)μmol/L after 7-14 days in RFA group vs (151.40 ±94.47) and (94.21 ±67.36)μmol/L in stent group.The changes of the two groups were of no statistical significances .The stent patenmedian time was 122 ( 9 -550 ) and 157 ( 16 -510 ) d, while the median survival was 125(9-550) and 163 ( 16 -520 ) d.The difference was of no statistical significance .Conclusion Percutaneous intraluminal RFA combined with biliary stenting and percutaneous transhepatic puncture combined with biliary stenting are both safe and feasible therapeutic options for unresectable malignant obstructive jaundice .There is no statistically significant diffference between the two groups in the recent and long-term curative effects .