Jarosova Jana, Macinga Peter, Hujova Alzbeta, Kral Jan, Urban Ondrej, Spicak Julius, Hucl Tomas
Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Praha 14021, Czech Republic.
Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentristry, Palacky University Olomouc, Olomouc 77900, Czech Republic.
World J Gastrointest Oncol. 2021 Oct 15;13(10):1383-1396. doi: 10.4251/wjgo.v13.i10.1383.
Cholangiocarcinoma and pancreatic cancer are the most common causes of malignant biliary obstruction. The majority of patients are diagnosed at a late stage when surgical resection is rarely possible. In these cases, palliative chemotherapy and radiotherapy provide only limited benefit and are associated with poor survival. Radiofrequency ablation (RFA) is a procedure for locoregional control of tumours, whereby a high-frequency alternating current turned into thermal energy causes coagulative necrosis of the tissue surrounding the catheter. The subsequent release of debris and tumour antigens by necrotic cells can stimulate local and systemic immunity. The development of endoluminal RFA catheters has led to the emergence of endoscopically delivered RFA, a treatment mainly used for malignant biliary strictures to prolong survival and/or stent patency. Other indications include recanalisation of occluded biliary stents and treatment of intraductal ampullary adenoma or benign biliary strictures. This article presents a comprehensive review of endobiliary RFA, mainly focusing on its use in patients with malignant biliary obstruction. The available data suggest that biliary RFA may be a promising modality, having positive impacts on survival and stent patency and boasting a reasonable safety profile. However, further studies with better characterised and stratified patient populations are needed before the method becomes accepted within routine clinical practice.
胆管癌和胰腺癌是恶性胆道梗阻最常见的病因。大多数患者在晚期才被诊断出来，此时很少能够进行手术切除。在这些情况下，姑息性化疗和放疗仅能带来有限的益处，且患者生存率较低。射频消融（RFA）是一种用于肿瘤局部控制的方法，通过将高频交流电转化为热能，使导管周围组织发生凝固性坏死。坏死细胞随后释放的碎片和肿瘤抗原可刺激局部和全身免疫。腔内RFA导管的发展导致了内镜下RFA的出现，这是一种主要用于恶性胆道狭窄以延长生存期和/或保持支架通畅的治疗方法。其他适应证包括闭塞性胆道支架再通以及导管内壶腹腺瘤或良性胆道狭窄的治疗。本文对胆管内RFA进行了全面综述，主要关注其在恶性胆道梗阻患者中的应用。现有数据表明，胆管RFA可能是一种有前景的治疗方式，对生存期和支架通畅率有积极影响，且安全性良好。然而，在该方法被纳入常规临床实践之前，还需要对更具特征性和分层的患者群体进行进一步研究。
