[1]葛乃建,黄 剑,杨业发,等.经皮胆管穿刺引流与经内镜鼻胆管引流胆管冷却保护技术在肝癌微波消融中的应用对比[J].介入放射学杂志,2018,27(01):35-39.
 GE Naijian,HUANG jian,YANG Yefa,et al.Intraductal cooling protection technique via PTCD tube versus via ENBD tube in percutaneous microwave ablation for HCC: a comparative study of the protective effect on bile duct thermal damage[J].journal interventional radiology,2018,27(01):35-39.
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经皮胆管穿刺引流与经内镜鼻胆管引流胆管冷却保护技术在肝癌微波消融中的应用对比()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
27
期数:
2018年01期
页码:
35-39
栏目:
非血管介入
出版日期:
2018-01-25

文章信息/Info

Title:
Intraductal cooling protection technique via PTCD tube versus via ENBD tube in percutaneous microwave ablation for HCC: a comparative study of the protective effect on bile duct thermal damage
作者:
葛乃建 黄 剑 杨业发 申淑群 于晓河 朱俊军 张一军 刘 学 吴孟超
Author(s):
GE Naijian HUANG jian YANG Yefa SHENG Shuqun YU Xiaohe ZHU Junjun ZHANG Yijun LIU Xue WU Mengchao
Mini- invasive Intervention Center, Affiliated Shanghai Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
关键词:
【关键词】 肝癌 MWA 胆道并发症 胆道冷却技术
文献标志码:
A
摘要:
【摘要】 目的 比较经皮肝胆管穿刺引流术(PTCD)与经内镜鼻胆管引流术(ENBD)置管灌注冷却液在近肝门部肝癌微波消融(MWA)中防止胆管热损伤的作用。方法 收集上海东方肝胆外科医院2013年9月至2016年9月因近肝门部肝癌行经皮肝穿刺MWA的23例患者临床资料,其中12例经PTCD置管,11例经ENBD置管于肿瘤旁胆管,向置管内快速持续灌注4℃ 0.9%NaCl溶液,再在B超引导下行MWA治疗。比较两组胆管热损伤、冷却技术相关并发症及肝癌复发情况。结果 平均随访20个月(3~36个月),23例患者均无手术相关死亡。两组各有1例术后形成胆汁瘤,PTCD组无明显冷却技术相关并发症,而ENBD组有4例(36.4%,P=0.037):1例(9.1%)乳头切开后出血、3例(27.3%)急性胰腺炎。两组原位复发率、肝内复发率及病死率均无明显差异(P=1.00, 0.77及0.61)。结论 近肝门部肝癌根治性MWA中,经PTCD与ENBD置管灌注冷却液是防止胆管热损伤可行、有效的方法,前者技术相关性并发症更少。

参考文献/References:

[1] Lau WY, Lau SH. The current role of radiofrequency ablation in the treatment of hepatocellular carcinoma[J]. Hepatobiliary Pancreat Dis Int, 2017, 16: 122- 126.
[2] De Cobelli F, Marra P, Ratti F, et al. Microwave ablation of liver malignancies: comparison of effects and early outcomes of percutaneous and intraoperative approaches with different liver conditions : New advances in interventional oncology: state of the art[J]. Med Oncol, 2017, 34: 49.
[3] Ohnishi T, Yasuda I, Nishigaki Y, et al. Intraductal chilled saline perfusion to prevent bile duct injury during percutaneous radiofrequency ablation for hepatocellular carcinoma[J]. J Gastroenterol Hepatol, 2008, 23: e410- e415.
[4] European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL- EORTC clinical practice guidelines: management of hepatocellular carcinoma[J]. J Hepatol, 2012, 56: 908- 943.
[5] 葛乃建, 黄 剑, 杨业发, 等. 经内镜鼻胆管引流胆管冷却保护技术在肝癌MWA中的应用[J]. 中华消化内镜杂志, 2016, 33: 34- 38.
[6] Abdelaziz A, Elbaz T, Shousha HI, et al. Efficacy and survival analysis of percutaneous radiofrequency versus microwave ablation for hepatocellular carcinoma: an Egyptian multidisciplinary clinic experience[J]. Surg Endosc, 2014, 28: 3429- 3434.
[7] Livraghi T, Meloni F, Solbiati L, et al. Complications of microwave ablation for liver tumors: results of a multicenter study[J]. Cardiovasc Intervent Radiol, 2012, 35: 868- 874.
[8] Ong SL, Gravante G, Metcalfe MS, et al. Efficacy and safety of microwave ablation for primary and secondary liver malignancies: a systematic review[J]. Eur J Gastroenterol Hepatol, 2009, 21: 599- 605.
[9] Kondo Y, Shiina S, Tateishi R, et al. Intrahepatic bile duct dilatation after percutaneous radiofrequency ablation for hepatocellular carcinoma: impact on patient’s prognosis[J]. Liver Int, 2011, 31: 197- 205.
[10] Ogawa T, Kawamoto H, Kobayashi Y, et al. Prevention of biliary complication in radiofrequency ablation for hepatocellular carcinoma- cooling effect by endoscopic nasobiliary drainage tube[J]. Eur J Radiol, 2010, 73: 385- 390.
[11] Dominique E, El Otmany A, Goharin A, et al. Intraductal cooling of the main bile ducts during intraoperative radiofrequency ablation[J]. J Surg Oncol, 2001, 76: 297- 300.
[12] Lam VW, Ng KK, Chok KS, et al. Safety and efficacy of radiofrequency ablation for periductal hepatocellular carcinoma with intraductal cooling of the central bile duct[J]. J Am Coll Surg, 2008, 207: e1- e5.
[13] Lieberman S, Goldin E, Lotem M, et al. Irrigation of the bile ducts with chilled saline during percutaneous radiofrequency ablation of a hepatic ocular melanoma metastasis[J]. AJR Am J Roentgenol, 2004, 183: 596- 598.
[14] 杨业发, 伍 路, 申淑群, 等. 胆管冷却技术在中央胆管旁肝癌MWA术中的应用[J]. 介入放射学杂志, 2014, 23: 1408- 1451.
[15] Navaneethan U, Konjeti R, Venkatesh PG, et al. Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications: an updated meta- analysis[J]. World J Gastrointest Endosc, 2014, 6: 200- 208.
[16] Christoforidis E, Vasiliadis K, Goulimaris I, et al. A single center experience in minimally invasive treatment of postcholecystectomy bile leak, complicated with biloma formation[J]. J Surg Res, 2007, 141: 171- 175.
[17] 葛乃建, 于晓河, 杨业发, 等. 新型胆道射频消融导管在离体猪肝应用的实验研究[J]. 临床肿瘤学杂志, 2014, 9: 790- 794.
[18] 葛乃建, 杨业发, 申淑群, 等. 经皮穿刺射频消融治疗门静脉癌栓15例[J]. 介入放射学杂志, 2014, 23: 883- 886.
[19] Pillai K, Akhter J, Chua TC, et al. Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model[J]. Medicine (Baltimore), 2015, 94: e580.

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备注/Memo

备注/Memo:
(收稿日期:2017-05-02)
(本文编辑:俞瑞纲)
更新日期/Last Update: 2018-01-26