目的：探讨经皮经肝双极射频消融（RFA）导管治疗恶性梗阻性黄疸的可行性、安全性及初步疗效。方法选取20例失去手术治疗机会的恶性胆道梗阻患者（其中2例胆道支架再堵塞），采用经皮经肝穿刺胆道路径双极RFA治疗，消融功率为5~12 W，单次消融时间为60~120 s，消融持续时间平均4．66 min（1．5~8．5 min），有效消融范围平均为5．76 cm（4~10 cm）。消融后导入球囊扩张阻塞段，再植入胆道金属支架，观察术后疗效、安全性及并发症。结果20例患者均成功完成RFA治疗：17例植入胆道支架，其中11例支架植入前用球囊扩张；1例单行球囊扩张术未放置支架；2例胆道支架再阻塞后消融（1例球囊扩张）。术后未出现胆漏、胆道感染、肝贯通伤、腹膜炎等并发症。20例胆道引流均获成功；中位随访期为3个月（0．5~10个月）；术后1、3个月分别有19例和14例支架通畅，术后1、3个月分别有19例和14例生存，随访期内，20例患者中8例生存，12例死亡。中位生存期为144 d（13~330 d），支架通畅中位时间为90 d（13~210 d）。12例死亡患者中8例因恶病质、多脏器功能衰竭死亡，但随访期内总胆红素等指标无升高。结论经皮肝穿刺胆道内导管射频消融术作为一种新型安全、可行的治疗方法，取得了一定疗效，但远期疗效仍有待进一步探讨。%Objective To investigate the feasibility, safety and clinical effect of percutaneous transhepatic bipolar radiofrequency catheter ablation in treating malignant obstructive jaundice. Methods Twenty patients with inoperable malignant biliary obstruction were enrolled in this study. Of the 20 cases , 2 had biliary stent re-occlusion. Percutaneous transhepatic bipolar radiofrequency catheter ablation was carried out in all patients. The ablation power was 5 - 12 W, single ablation time was 60 - 120 s, the average duration of ablation was 4.66 min (1.5 - 8.5 min), and the mean effective ablation extent was 5.76 cm (4 -10 cm). After ablation, balloon catheter was inserted to dilate the occluded segment, which was followed by implantation of biliary metal stent. The clinical efficacy , safety and complications were recorded. Results Percutaneous transhepatic bipolar radiofrequency catheter ablation was successfully completed in all the 20 patients. Implantation of biliary metal stent was performed in 17 patients , among them balloon dilatation was employed in 11 patients before stent implantation , simple balloon dilatation with no stent implantation was employed in one patient, and ablation was adopted after biliary stent re-occlusion occurred in two patients. After the ablation, no complications such as biliary fistula, biliary tract infections, liver penetrating injuries, peritonitis, etc. occurred. Biliary drainage was successfully completed in all patients. The median follow-up period was three months(0.5-10 months); the stent patency rate at the end of one and three months was 100% (19/19) and 79% (11/14) respectively. The one-month and 3-month survival rate was 95% (19/20) and 93% (14/15) respectively. During the follow-up period, 8 of the 20 patients were alive and 12 died. The median survival time was 144 days (13 - 330 days) and the median time of stent patency was 60 days (30-210 days). Of the 12 fatal patients, 8 died of cachexia with multi- system failure although their total bilirubin level was not elevated during the follow- up period. Conclusion For the treatment of malignant obstructive jaundice, percutaneous transhepatic bipolar radiofrequency catheter ablation is a newly-developed, safe and feasible means. Clinically, this technique has already achieved some certain effect although its long-term results need to be further evaluated.
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