Ge Naijian, Huang Jian, Shi Zhiyong, Yu Xiaohe, Shen Shuqun, Wu Xiaobing, Zhou Jing, Hang Qinqin, Yang Yefa
Mini-invasive Intervention Center, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China.
The No.1 Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China.
J Interv Med. 2019 Jul 31;2(2):84-90. doi: 10.1016/j.jimed.2019.07.004. eCollection 2019 May.
Biliary thermal injury caused by microwave ablation (MWA) for a hepatocellular carcinoma (HCC) close to the central bile ducts always results in severe complications and leads to mortality. Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications. In this study, we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage (PTCD) tube for preventing biliary thermal injury caused by MWA, and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage (ENBD) tube.
Participants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube. The main study outcomes were bile duct complications related to MWA and local tumor recurrence. p value < 0.05 was considered to indicate a statistically significant difference.
A total of 23 patients with an HCC (23 nodules) close to a central bile duct were enrolled in this study. Of these patients, 12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions. There were no PTCD- and ENBD-related mortality cases. There was no complication related to the PTCD procedure; however, 3 patients (27.27%) developed acute pancreatitis and 1 patient (9.09%) had hemorrhage in the ENBD group (p = 0.037). One patient (8.33%) in the PTCD group had bile leakage and 2 patients (18.18%) in the ENBD group developed a biloma. Within 5 years, 1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence. There was no significant difference in local recurrence, nonlocal hepatic recurrence, mortality rate, or median cumulative overall survival between the 2 groups.
The intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts. It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.
对于靠近中央胆管的肝细胞癌（HCC），微波消融（MWA）引起的胆管热损伤常导致严重并发症并可致死。一些研究表明，热消融期间用冷盐水对胆管进行管腔内冷却可成功预防这些并发症。在本研究中，我们介绍一种通过经皮经肝胆管引流（PTCD）管预防MWA所致胆管热损伤的新型胆管冷却技术，并比较经PTCD管和经内镜鼻胆管引流（ENBD）管进行管腔内冷却技术的可行性和安全性。
参与者被随机分配接受通过PTCD管或ENBD管进行管腔内冷盐水灌注的HCC的MWA。主要研究结局为与MWA相关的胆管并发症和局部肿瘤复发。p值<0.05被认为具有统计学显著差异。
本研究共纳入23例靠近中央胆管的HCC患者（23个结节）。这些患者中，12例放置了PTCD管，11例在靠近病变的肝管中放置了ENBD管。没有与PTCD和ENBD相关的死亡病例。没有与PTCD操作相关的并发症；然而，ENBD组有3例患者（27.27%）发生急性胰腺炎，1例患者（9.09%）出现出血（p = 0.037）。PTCD组有1例患者（8.33%）发生胆漏，ENBD组有2例患者（18.18%）形成胆汁瘤。5年内，PTCD组有1例患者、ENBD组有2例患者出现局部复发。两组之间在局部复发、非局部肝复发、死亡率或中位累积总生存率方面没有显著差异。
使用PTCD管的管腔内冷却技术是预防靠近中央胆管的HCC的MWA所致胆管热损伤的一种可行且有效的方法。它不会增加局部复发，可能比通过ENBD管进行管腔内冷却更安全。
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