ERCP联合胆道子镜引导下射频消融治疗不可切除肝门部胆管癌的疗效与安全性分析

Analysis of the efficacy and safety of ERCP combined with cholangioscopy-guided radiofrequency ablation for unresectable hilar cholangiocarcinoma

摘要

目的 探讨经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）联合胆道子镜引导下射频消融治疗不可切除肝门部胆管癌的疗效与安全性分析。方法 回顾性分析2021年1月—2023年1月在河北省沧州市中心医院接受治疗的不可切除肝门部胆管癌患者100例,按是否行射频消融（radiofrequency ablation,RFA）分为2组,RFA组（50例）和单纯ERCP组（50例）,观察2组疗效与安全性等情况。结果 RFA组手术时间高于单纯ERCP组,黄疸缓解率、胆管狭窄改善率高于单纯ERCP组,差异有统计学意义（P<0.05）,2组住院时间比较差异无统计学意义（P>0.05）;RFA组总有效率为62.0%、疾病控制率为92.0%,单纯ERCP组总有效率为38.0%、疾病控制率为76.0%,2组上述指标相比差异有统计学意义（P<0.05）;术前2组患者肝功能指标及肿瘤标志物指标水平的比较,差异无统计学意义（P>0.05）,术后1个月相比,2组肝功能指标及肿瘤标志物指标较术前水平降低（P<0.05）,但RFA组与单纯ERCP组相比差异无统计学意义（P>0.05）;RFA组术后总并发症的发生率12.0%,而单纯ERCP组术后总并发症的发生率16.0%,比较2组术后总并发症的发生率,差异无统计学意义（P>0.05）,所有并发症经非手术治疗后均治愈,无严重并发症及死亡病例;RFA组6个月、12个月、24个月生存率及中位PFS分别为88.0%、66.0%、34.0%、19.50（9.50）个月,单纯ERCP组6个月、12个月、24个月生存率及中位PFS分别为76.0%、52.0%、20.0%、13.0（8.00）个月;RFA组中位PFS及各时间点生存率均高于单纯ERCP组,差异有统计学意义（P<0.05）。结论 ERCP联合胆道子镜引导下射频消融治疗不可切除肝门部胆管癌具有一定临床获益,可在一定程度上改善患者远期预后,且整体安全性良好,值得临床进一步研究与应用。

Abstract

Objective To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography （ERCP） combined with cholangioscopy-guided radiofrequency ablation （RFA） for unresectable hilar cholangiocarcinoma （HCCA）. Methods A retrospective analysis was carried out on 100 patients diagnosed with unresectable HCCA at Cangzhou Central Hospital, Hebei Province, between January 2021 and January 2023. These patients were divided into two groups according to administration of radiofrequency ablation （RFA）： the RFA group （n=50） and the ERCP-only group （n=50）. The therapeutic effect and safety profile of the two groups were evaluated. Results The duration of operation was longer in the RFA group than in the ERCP-only group. The jaundice relief rate and the improvement rate of bile duct stenosis in the RFA group were higher than those in the ERCP-only group, showing significant differences （P<0.05）. There was no significant difference in the length of hospitalization between the two groups （P>0.05）. The total effective rate of the RFA group was 62.0% and the disease control rate was 92.0%, while the total effective rate of the ERCP-only group was 38.0% and the disease control rate was 76.0%; The differences in these indicators between the two groups were statistically significant （P<0.05）. Before the operation, the levels of liver function indicators and tumor markers in the two groups were not statistically different （P>0.05）. Compared with those before the operation, the levels of liver function indicators and tumor markers in both groups decreased at 1 month after the operation （P<0.05）, but there was no significant difference between the RFA group and the ERCP-only group （P>0.05）. The postoperative total complication rate was 12.0% in the RFA group and 16.0% in the ERCP-only group, showing no significant difference （P>0.05）. All complications were cured after conservative treatment, and there were no severe complications or deaths. The 6-month, 12-month, and 24-month survival rates and median PFS in the RFA group were 88.0%, 66.0%, 34.0%, and 19.50 （9.50） months, respectively, while those in the ERCP-alone group were 76.0%, 52.0%, 20.0%, and 13.00 （8.00） months, respectively. The median PFS and survival rates at each time point in the RFA group were higher than those in the ERCP-alone group, with statistically significant differences （P<0.05）. Conclusion ERCP combined with cholangioscopy-guided RFA for unresectable HCCA has certain clinical benefits. It can improve the long-term prognosis of patients to a certain extent and has good overall safety; Therefore, it is worthy of further clinical research and application.

关键词

胆管肿瘤 / 胰胆管造影术,内窥镜逆行 / 射频消融术

Key words

bile duct neoplasms / cholangiopancreatography,endoscopic retrograde / radiofrequency ablation