Dutta Amit Kumar, Basavaraju Umesh, Sales Laura, Leeds John Samuel
a Department of Gastroenterology , Aberdeen Royal Infirmary , Foresterhill Road, Aberdeen , UK.
Expert Rev Gastroenterol Hepatol. 2017 Aug;11(8):779-784. doi: 10.1080/17474124.2017.1314784. Epub 2017 Apr 7.
Radiofrequency ablation (RFA) causes coagulative necrosis of tissue and may be beneficial prior to biliary stenting. We report our experience using RFA for malignant biliary obstruction and review the literature.
Retrospective analysis of all patients undergoing RFA for malignant biliary obstruction over the last two years. Success, complications and re-intervention following RFA were assessed. Controls were age, sex and disease matched who had stenting alone.
31 patients were included and 15 patients underwent biliary RFA prior to stenting (median age 78 years, 8 females). 14 patients had pancreatic cancer, 13 cholangiocarcinoma (6 hilar lesions) and 4 malignant disease invading the bile duct. Adverse events included acute pancreatitis (n = 2) and bacteremia in (n = 1). Median duration of intervention free survival was 220 days in the RFA group compared to 106.5 days in controls (hazard ratio 2.4, 95% CI 1.1 - 5.3, p = 0.025). Multivariable Cox proportional hazard analysis showed survival was associated with RFA (hazard ratio 2.55, 95% CI 1.09-5.96, p = 0.026) but not age, site or type of malignancy.
Biliary RFA is a technically feasible with a low adverse event rate and is associated with increased survival. Multi-centre randomized controlled trials are required.
射频消融（RFA）可导致组织凝固性坏死，在胆道支架置入术前可能有益。我们报告了我们使用RFA治疗恶性胆道梗阻的经验并复习了文献。
回顾性分析过去两年中所有接受RFA治疗恶性胆道梗阻的患者。评估RFA后的成功率、并发症及再次干预情况。对照组为年龄、性别和疾病相匹配且仅接受支架置入术的患者。
纳入31例患者，其中15例患者在支架置入术前接受了胆道RFA（中位年龄78岁，8例女性）。14例患者患有胰腺癌，13例胆管癌（6例肝门部病变），4例恶性疾病侵犯胆管。不良事件包括急性胰腺炎（n = 2）和菌血症（n = 1）。RFA组的无干预生存期的中位数为220天，而对照组为106.5天（风险比2.4，95%可信区间1.1 - 5.3，p = 0.025）。多变量Cox比例风险分析显示，生存期与RFA相关（风险比2.55，95%可信区间1.09 - 5.96，p = 0.026），但与年龄、肿瘤部位或类型无关。
胆道RFA技术上可行，不良事件发生率低，且与生存期延长相关。需要进行多中心随机对照试验。
