CT引导热消融联合金属支架植入治疗不可切除胆管癌患者的效果观察

摘要/Abstract

摘要： 目的观察CT引导热消融联合金属支架植入治疗不可切除胆管癌患者的效果。方法纳入2017年3月至2021年12月中国人民解放军联勤保障部队第九〇四医院收治的不可切除胆管癌患者106例,采用单纯随机抽样法分为对照组(金属支架植入)、观察组(射频消融+金属支架植入),各53例。比较两组手术情况,测量天冬氨酸氨基转移酶(AST)、总胆红素(TBil)等指标,记录两组并发症发生率、胆道通畅时间、生存时间、生存率,制作生存曲线。结果观察组手术时间为(98.2±13.7)min,高于对照组(49.6±5.8)min,差异有统计学意义(P<0.05);治疗后,观察组血清TBil、AST、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)含量分别为(48.7±12.6)μmol/L、(33.5±6.8)U/L、(54.7±11.4)U/L、(226.3±37.8)U/L、(241.7±36.2)U/L,显著低于对照组,分别为(91.6±20.5)μmol/L、(57.8±14.2)U/L、(72.5±9.3)U/L、(285.6±53.9)U/L、(342.8±49.5)U/L,差异有统计学意义(P<0.05)。观察组和对照组并发症发生率分别为26.4%、20.8%,差异无统计学意义(P>0.05)。随访18个月后,观察组胆道通畅时间、生存时间及18个月生存率分别为(8.7±1.4)个月、(13.6±1.9)个月、52.8%,显著高于对照组(5.9±1.1)个月、(9.7±1.4)个月、32.1%(P<0.05)。结论 CT引导热消融与金属支架植入相结合的治疗方法,在治疗不可切除胆管癌患者方面效果显著,有利于改善患者的肝功能,延长胆道通畅时间和生存时间,提高患者的18个月内生存率,而术后并发症发生率未明显升高。

关键词: 胆管癌, 不可手术切除, 射频消融, 支架, 生存曲线

Abstract: Objective This study aimed to evaluate the therapeutic effect of combining percutaneous CT-guided thermal ablation with biliary metal stent placement for patients with non-operable cholangiocarcinoma. Methods From March 2017 to December 2021, 106 patients in the 904th Hospital of the Joint Service Support Force of the Chinese People′s Liberation Army with unresectable cholangiocarcinoma were involved and randomly divided into control group (metal stent implantation) and observation group (radiofrequency ablation+metal stent implantation), with 53 cases in each group. The operation conditions of the two groups were compared, and serum levels of aspartate aminotransferase (AST), total bilirubin (TBil) and other indicators were measured. The incidence of complications, biliary tract patency time, survival time and survival rate of the two groups were recorded, and the survival curve was made. Results The operative time in the observation group was (98.2 ± 13.7) min, which was longer than that in the control group (49.6 ± 5.8) min, with a statistically significant difference (P< 0.05). After treatment, the serum levels of TBil, AST, alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (γ-GT) in the observation group were (48.7±12.6) μmol/L, (33.5±6.8) U/L, (54.7±11.4) U/L, (226.3±37.8) U/L, and (241.7±36.2) U/L, respectively, significantly lower than those in the control group: (91.6±20.5) μmol/L, (57.8±14.2) U/L, (72.5±9.3) U/L, (285.6±53.9) U/L, and (342.8±49.5) U/L, with statistically significant differences (P<0.05). The complication rates in the observation group and the control group were 26.4% and 20.8%, respectively, showing no significant difference (P>0.05). After 18 months of follow-up, the biliary patency duration, survival time, and 18-month survival rate in the observation group were (8.7±1.4) months, (13.6±1.9) months, and 52.8%, respectively, which were significantly higher than those in the control group: (5.9±1.1) months, (9.7±1.4) months, and 32.1% (P<0.05). Conclusion The combination of CT-guided thermal ablation and metal stent implantation is effective in the treatment of patients with unresectable cholangiocarcinoma, which is conducive to improving the liver function, prolonging the biliary patency duration and survival time of stents and improving the survival rate of patients within 18 months, but the incidence of postoperative complications has not been significantly improved.

Key words: Cholangiocarcinoma, Inoperable, Radio frequency ablation, Stand, Survival curve

郎渭蔚, 陆泽华, 耿承军. CT引导热消融联合金属支架植入治疗不可切除胆管癌患者的效果观察[J]. 肝脏, 2026, 31(4): 521-524.

LANG Wei-wei, LU Ze-hua, GENG Cheng-jun. Observation on the effect of CT-guided thermal ablation combined with metal stent implantation in the treatment of unresectable cholangiocarcinoma patients[J]. Chinese Hepatolgy, 2026, 31(4): 521-524.

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