| Background and Aims :Malignant biliary obstruction mainly caused by the bile duct carcinoma,carcinoma of pancreas,gallbladder cancer,is a highly malignant tumors-group,which have jaundice,hyperbilirubinemia and bile duct dilatation.Progress of malignant bile duct obstruction is always occult and often late to be diagnosed.Only about 10% to 20% of the bile duct malignant obstruction patients could be considered about operation.And for unresectable patients,the palliative treatment is the only choice.With the continuous development of clinical research,percutaneous transhepatic choledochus drainage and endoscopic palliative treatment to relieve biliary obstruction has become the mainstream for these unresectable patients of malignant bile duct obstruction.But with the growth of tumors and bile duct sedimentation,stents were soon blocked and lost their efficacy and prolongation of biliary stent patency was have great clinical significance for improved the quality of life of patients and prolong their survival time.Radiofrequency ablation RFA is a new treatment of malignant tumors with significant effect and widely used.The purpose of this study is to compare the clinical effect of percutaneous intraluminal RFA combined with biliary metallic stenting and biliary metallic stenting only in the treatment of malignant biliary obstructive.Methods:A total of 34 patients with unresectable maliganant obstruction billary were retrospective analysis,among which 19 patients had percutaneous intraluminal RFA combined with biliary metallic stenting(RFA group);while simultaneously 15 patients were selected for the simple biliary metallic stent implantation(drainage group).The changes of the serum total bilirubin(TB)was observed pre-operation and post-operation.Complications,stent patency and the survival were compared in these two groups.All thepatients were follow-up by telephone and out-patient.SPSS version 17.0was used for statistical analysis.Fisher exact probability method was used to compare sex,location of tumor,rate of complication,rate of stent patency and survival rate.Mann-Whitney U rank sum test was used for other parameters of nominal variables.Metrological data are expressed as a median and count data are expressed as a percentage.All test results was statistically significant as P volume <0.05.Results:There were no significant statistical different of age,sex and biliary obstruction site(P>0.05).All the patients completed the operation successfully and no surgery related complications occurred.There were 6 cases had biliary tract infect in RFA group and 4patients in drainage group,who were cured by antibiotics.TB was 456 umol/L before treatment in RFA group,TB was120 umol/L after treatment 5-7d in RFA group.TB was 471umol/L before treatment in drainage group,TB was 140umol/L after treatment 5-7d in drainage group.There were obvious statistical significances before and 5-7days after treatment in each group(P<0.05),but the changes of two groups had no statistical significances(P>0.05).The rate of stent patencys were 84.21%(3months),68.42%(6months)and21.05%(12months)in RFA group and 80.00%(3months),26.67%(6months)and6.67 %(12months)in drainage group,which is statistical significance in 6months after operation.The median survival were 11 months in RFA group and 7.5 months in drainage group,that different of two groups was statistical significance(p<0.03).Conclusion:Percutaneous intraluminal RFA combined with biliary metallic stenting and biliary metallic stenting only both were safe and effective therapeutic options for unresectable malignant biliary obstructive.According to our study that percutaneous intraluminal RFA combined with biliary metallic stenting had prolong stent patency and survival time of patients and had satisfactory short-term effect.The shortcomings of this study are results of retrospective study and small number of cases,that could be improved by multicenter randomized controlled trial. |
PDF Full Text Request