ERCP引导下射频消融联合化疗治疗胆管癌患者疗效及影响预后因素分析

doi:10.3969/j.issn.1672-5069.2018.04.013

摘要/Abstract

摘要： 目的探讨在内镜逆行性胰胆管造影术（ERCP）引导下射频消融结合化疗治疗胆管癌患者的疗效及影响预后的因素。方法 2009年1月~2014年12月我院收治的96胆管癌患者被分为对照组48例和观察组48例,给予对照组患者经ERCP引导下行射频消融治疗,观察组在对照组治疗的基础上予以联合化疗治疗,比较两组近期临床疗效,统计分析所有患者的预后生存情况,采用Cox回归分析影响患者术后生存的相关因素。结果治疗后,观察组患者血清TBIL为（72.6±22.2） μmol/L,GGT为（262.2±64.6） U/L和ALP为（206.4±62.6） U/L,均明显低于对照组的（102.6±32.4） μmol/L、GGT（382.4±102.4） U/L和ALP（284.4±86.4） U/L,而ALB（42.4±10.8）g/L明显高于对照组[（36.2±10.6） g/L,P<0.05];观察组患者近期临床总有效率（91.6%）明显高于对照组（75.0%,x²=4.800,P=0.028）;观察组和对照组3 a生存率分别为58.3%和29.2%（x²=8.296,P=0.004）,两组3 a无复发生存率分别为54.1%和25.0%（x²=8.537,P=0.003）;单因素Cox回归分析发现,年龄、肿瘤位置、数目、分化程度、临床分期、CEA水平和治疗方法均可能影响胆管癌患者的预后（P<0.05）;多因素Cox回归模型分析发现,肿瘤低分化（HR=1.84,95%CI:1.05~3.23）、Ⅲ、Ⅳ期（HR=1.76,95%CI:1.03~3.02）、发生转移（HR=1.81,95%CI:1.05~3.12）和术后未进行化疗（HR=1.84,95%CI: 1.03~3.27）为影响胆管癌患者预后的独立危险因素（P<0.05）。结论 ERCP引导下射频消融结合化疗可明显提高胆管癌患者近期临床治疗有效率、延长生存时间和改善预后。针对影响胆管癌患者预后的独立危险因素进行及时处理,或许能提高疗效。

关键词: 胆管癌, 内镜下逆行性胰胆管造影术, 射频消融, 化疗, 治疗

Abstract: Objective To investigate the efficacy and prognosis of retrograde cholangiopancreatography （ERCP）-guided radiofrequency ablation combined with chemotherapy in treatment of patients with cholangiocarcinoma. Methods The clinical and follow-up data of 96 patients with cholangiocarcinoma admitted to our hospital between January 2009 and December 2014 were retrospectively analyzed. The patients were divided into control group and observation group with 48 cases in each group. The patients in the control group were treated with ERCP-guided radiofrequency ablation and the patients in the observation group were given chemotherapy on the basis of ERCP-guided radiofrequency ablation. The recent clinical outcomes were compared between the two groups. The prognosis of all patients was statistically analyzed and the survival was compared. Cox regression analysis was performed to explore the factors affecting the patients' survival. Results The levels of serum bilirubin was （72.6±22.2） μmol/L vs. （102.6±32.4） μmol/L,GGT was （262.2±64.6） U/L vs. （382.4±102.4） U/L and ALP was （206.4±62.6） U/L vs. （284.4±86.4） U/L,and serum albumin levels was （42.4±10.8） g/L vs.（36.2±10.6） g/L,all significantly different between the two groups（P<0.05）;the clinical effective rate in the observation group was remarkably higher than in the control group（91.6% vs. 75.0%,x²=4.800,P=0.028）;the 3 year overall survival rates in the observation group and the control group were 58.3% vs. 29.1%,respectively,and difference was statistically significant （x²=8.296,P=0.004）;the 3 year recurrence-free survival rate in the two groups were 54.2% and 25.0%,respectively,and the difference was statistically significant between the two groups（x²=8.537,P=0.003）;univariate Cox regression analysis showed that age,tumor location,number,differentiation,clinical stage,CEA level and treatment were all likely to affect the prognosis of patients with cholangiocarcinoma（P <0.05）;multivariate Cox regression analysis showed that the poor tumor differentiation（HR=1.84,95%CI:1.05-3.23）, stage III and IV（HR=1.76,95%CI:1.03-3.02）,metastasis （HR=1.81 95%CI:,1.05-3.12） and without chemotherapy after surgery （HR=1.84,95%CI: 1.03-3.27） were all independent factors influencing the prognosis of patients with cholangiocarcinoma（P<0.05）. Conclusions ERCP-guided radiofrequency ablation combined with chemotherapy could significantly improve the clinical efficacy of patients with cholangiocarcinoma,prolong the survival and ameliorate the prognosis. Taking the influencing factors into consideration and managing them in time might further improve the efficacy.

Key words: Cholangiocarcinoma, Endoscopic retrograde cholangiopancreatography, Radiofrequency ablation, Chemotherapy, Therapy

吴泉霖, 何耀鹏. ERCP引导下射频消融联合化疗治疗胆管癌患者疗效及影响预后因素分析[J]. 实用肝脏病杂志, 2018, 21(4): 537-540.

Wu Quanlin, He Yaopeng. Efficacy of ERCP-guided radiofrequency ablation combined with chemotherapy in treatment of patients with cholangiocarcinoma[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(4): 537-540.

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