中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

Clinical effect of biliary stenting combined with percutaneous transhepatic cholangial drainage in treatment of different types of malignant obstructive jaundice

DOI: 10.3969/j.issn.1001-5256.2019.01.025
Research funding:

 

  • Published Date: 2019-01-20
  • Objective To investigate the clinical effect and surgical experience of percutaneous transhepatic cholangial drainage (PTCD) combined with biliary stenting in patients with different types of malignant obstructive jaundice (MOJ) .Methods A retrospective analysis was performed for the early clinical outcomes of 185 patients with MOJ who were admitted to Beijing Air Force General Hospital from July2013 to July 2018 and underwent PTCD combined with biliary stenting.Major observation indices included location and type of obstruction, related hematological parameters before surgery and at 3-5 and 6-10 days after surgery, including total bilirubin (TBil) , direct bilirubin (DBil) , alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase, and stent implantation.The t-test was used for comparison of normally distributed continuous data between two groups, and an analysis of variance was used for comparison between three groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between three groups.The chi-square test was used for comparison of categorical data between groups.Results Of all 185 patients, 102 had low-level obstruction, 75 had high-level obstruction, 4had complete biliary obstruction, and 4 had anastomotic obstruction.All patients underwent PTCD+biliary stenting successfully, and catheter drainage was performed with a technical success rate of 100%.A total of 233 stents were implanted for 185 patients, and all patients had reduced jaundice, increased appetite, and improved liver function after surgery, among whom 146 had marked response and 39 had response.The patients with low-level obstruction had a significantly better surgical outcome than those with high-level obstruction (χ2=10.866, P=0.001) .There was no significant difference in bilirubin between the patients with type I high-level obstruction who underwent single-stent drainage and those who underwent double-stent drainage before and after surgery (P>0.05) .The patients with typeⅡ/Ⅲ/Ⅳhigh-level obstruction who underwent double-stent drainage had a significantly better outcome than those underwent single-stent drainage (χ2=6.412, P=0.011) , as well as significantly lower levels of TBil and DBil at 6-10 days after stent drainage (t=2.62 and2.06, P<0.05) .ConclusionPTCD combined with biliary stenting can improve liver function, appetite, and quality of life in patients with MOJ, and patients with low-level obstruction have significantly better outcomes than those with high-level obstruction.Double-stent drainage is recommended for patients with typeⅡ/Ⅲ/Ⅳhigh-level obstruction.Biliary stenting also has a good clinical effect in patients with complete biliary obstruction and anastomotic obstruction, and biliary and duodenal stenting can be performed for patients with biliary obstruction combined with duodenal obstruction.

     

  • 肝细胞癌(简称肝癌)术后复发是导致患者死亡的主要原因[1]。对于复发性肝癌,临床上常用的治疗方法包括再次肝切除术、射频消融(radiofrequency ablation,RFA)、肝移植、介入、靶向药物治疗等[2]。然而,目前国内外肝癌诊疗指南均未对复发性肝癌提供具体的诊疗推荐。再次肝切除术和RFA属于根治性治疗方法,临床应用广泛,文献报道较多。但单个研究样本量小,且研究间的结论不统一,临床上对复发性肝癌的根治性治疗方案尚存争议。本文使用Meta分析的方法,客观分析两种治疗措施对复发性肝癌的疗效与安全性。

    系统检索PubMed、中国知网和万方数据库,检索日期自建库至2020年6月15日。英文检索词包括:recurrent、recurrence、hepatocellular carcinoma、liver cancer、hepatic resection、hepatectomy、resection、radiofrequency ablation等,中文检索词包括:复发、肝癌、肝细胞癌、手术、再次肝切除术、射频消融等。

    (1) 研究:比较再次肝切除术与RFA治疗复发性肝癌的随机对照试验或队列研究,英文或中文发表。(2)患者:罹患原发性肝癌,接受首次肝切除术治疗后,肝癌复发,复发肿瘤符合米兰标准,且无大血管侵犯及肝外转移。(3)干预措施:肝癌复发后,接受再次肝切除术或RFA治疗。(4)结局指标:报道了总生存期(overall survival,OS)、无瘤生存期(recurrence-free survival,RFS)、围手术期并发症和围手术期病死率中的任何一项。

    (1) 肝切除和RFA治疗原发性肝癌、胆管细胞癌或转移性肝癌的研究;(2)单组样本量过小(<10例)或单臂研究;(3)未提供病例具体纳入时间段的研究;(4)肝癌复发后,接受再次肝切除术或RFA治疗前,接受其他的治疗方案(如介入、靶向药物等)。再次肝切除术或RFA治疗后,序贯介入或其他治疗措施,不在排除标准范围之内。对于重复性发表的研究,仅纳入样本量最大的一项。

    两位评价者独立检索并提取纳入文献的数据,数据提取过程中若有分歧则通过双方讨论或询问第3位评价者解决。提取的数据包括人口统计学资料及临床基线数据、OS、RFS、围手术期并发症发生率及病死率。若原始文献未详细描述生存数据,则从其Kaplan-Meier生存曲线图估算。

    统计分析采用RevMan 5.4.1软件(Cochrane协作组,牛津,英国)。采用从纳入文献提取的风险比(HR)进行OS和RFS的Meta分析。统计学异质性的评估采用I2检验。I2≥50%时采用随机效应模型,I2<50%时采用固定效应模型。P<0.05为差异有统计学意义。采用漏斗图估计发表偏倚。由于纳入文献提供的数据存在一定的局限性,无法根据患者性别、肿瘤大小、肿瘤个数、肿瘤位置等进行亚组分析。

    根据纳入和排除标准,18篇回顾性队列研究[3-20]和2篇随机对照试验[21-22]比较了再次肝切除术和RFA治疗复发性肝癌的临床疗效与安全性,共2903例患者(图 1)。全部纳入患者均来自亚洲国家,基线数据详见表 1

    图  1  文献检索流程图
    表  1  纳入研究的基线特点
    第一作者和年份 国家/地区 纳入时间(年) 组别 样本量 男/女(例) 年龄(岁) 单个/多个肿瘤(例) 复发肿瘤直径(cm) 肝硬化[例(%)] CTP分级(A/B/C,例) 随访(月)
    Wang 2015[3] 中国 2004—2010 肝切除 128 113/15 50.2±10.1 89/39 2.4±0.9 66(51.6) - -
    RFA 162 148/14 52.7±10.9 107/55 2.3±0.7 - - -
    Sun 2017[4] 中国台湾 2002—2014 肝切除 43 34/9 60(35~76) - 1.9(0.8~3.0) 36(83.7) 42/1 53
    RFA 57 38/19 63(27~81) - 1.8(1.0~3.0) 50(87.7) 57/0 54
    Umeda 2011[5] 日本 1998—2007 肝切除 29 - - - 3.20±0.57 - 29/0 48
    RFA 58 - - - 2.1±0.3 - 51/7 48
    Song 2015[6] 韩国 1994—2012 肝切除 39 31/8 52.5±9.8 32/7 2.2±1.1 23(59) 39/0 36.3(0.8~126.6)
    RFA 178 145/33 55.4±10.6 156/22 1.7±0.6 130(73.0) 172/6 44.7(5.6~139.8)
    Liang 2008[7] 中国 1999—2007 肝切除 44 39/5 48.8±12.0 34/10 ≤3 (26) - 44/0 33.5±24.1
    RFA 66 54/12 54.6±10.8 48/18 ≤3 (44) - 64/2 21.1±19.1
    Ho 2012[8] 中国台湾 2001—2007 肝切除 54 40/14 56.3±12.3 - 2.9±1.8 26(48.1) 51/2/1 32(0~79)
    RFA 50 39/11 61.0±11.1 - 2.3±1.9 28(56.0) 50/0 27(0~96)
    Chan 2012[9] 中国香港 2001—2008 肝切除 29 - 52(38~79) 21/8 2.1(0.8~5.5) 25(86.2) 29/0 44.9
    RFA 45 - 59(36~80) 29/16 2.2(0.8~6.0) 40(88.9) 40/5 44.9
    Chen 2018[10] 中国 2009—2015 肝切除 48 41/7 73.5±3.5 28/20 2.6±1.1 41(85.4) 39/9 36.9(2~78)
    RFA 57 51/6 73.7±2.9 30/27 2.5±1.2 49(86.0) 45/12 37.3(2~78)
    岑峰2016[11] 中国 2011—2015 肝切除 28 22/6 53.6 12/16 - 23(82.1) 18/10 -
    RFA 24 19/5 55.7 10/14 - 19(79.2) - -
    陈康2019[12] 中国 2005—2014 肝切除 77 65/12 - - - 57(74) 76/1 57(2~168)
    RFA 82 72/10 - - - 50(61) 77/5 51(4~111)
    黄新辉2013[13] 中国 2007—2011 肝切除 66 51/15 50.5±10.1 66/0 2.9±1.1 57(86.3) 66/0 -
    RFA 46 36/10 54.1±12.1 46/0 2.6±0.9 39(84.8) 46/0 -
    梁惠宏2011[14] 中国 1999—2009 肝切除 72 65/7 49±12 72/0 2.1±0.1 - 70/2 36±25
    RFA 79 69/10 55±11 79/0 2.5±0.1 - 73/6 32±21
    任正刚2008[15] 中国 2000—2005 肝切除 145 127/18 51 127/18 2.0 - 145/0 23(3~88)
    RFA 68 64/4 52 52/16 2.0 - 68/0 23(3~88)
    田正灵2016[16] 中国 2012—2015 肝切除 30 28/2 48.8±9.6 24/6 - 24(80) - 17(6.0~42.5)
    RFA 27 26/1 50.9±10.1 19/8 - 23(85.2) - 17(6.0~42.5)
    张辉2013[17] 中国 2003—2011 肝切除 69 - - - 3.5 61(88.4) 54/15 -
    RFA 99 - - 2.1 76(76.8) 71/28 -
    张婷婷2014[18] 中国 1998—2010 肝切除 27 25/2 47±13 25/2 3.2±1.1 - 27/0 32(9~118)
    RFA 39 37/2 52±13 37/2 2.7±1.1 - 37/2 28(2~79)
    Peng 2018[19] 中国 2006—2015 肝切除 79 67/2 55 59/20 ≤3(48) - - 53.2(4~96)
    RFA 107 95/12 57 75/32 ≤3(73) - - 52.3(3~96)
    Lu 2020[20] 中国 2004—2015 肝切除 138 124/16 50.1±10.9 112/26 2.8±1.9 96(70) 138/0 37.6
    RFA 194 172/22 52.9±11.8 162/32 1.9±0.9 134(69) 194/0 41.6
    Xia 2019[21] 中国 2010—2013 肝切除 120 107/13 52.4(25.7~60.5) 96/24 2.9(1.0~5.0) 50(41.7) 120/0 44.3(4.3~90.6)
    RFA 120 109/11 53.5(28.0~59.9) 94/26 2.7(1.0~4.8) 55(45.8) 120/0 44.3(4.3~90.6)
    刘嘉龙2019[22] 中国 2016—2017 肝切除 39 38/1 50.0±10.0 37/2 2.1±0.7 37(94.9) 38/1 24
    RFA 41 37/4 48.9±11.3 39/2 1.8±0.8 39(95.1) 39/2 24
    注:-,未报道。
    下载: 导出CSV 
    | 显示表格

    15篇文献[4, 6-7, 9-17, 19, 21-22]报道了再次肝切除术围手术期并发症发生率为5.5%~68.2%,中位值为22.4%,常见并发症包括肝功能不全、胸腔积液、腹水、胆瘘等。14篇文献[4, 6-7, 9-10, 12-17, 19, 21-22]报道了RFA的围手术期并发症发生率为0~13%,中位值为3.3%,常见并发症包括胆漏、腹腔出血等。16篇文献[4, 6-7, 9-19, 21-22]报道了再次肝切除术和RFA围手术期病死率,其中6篇文献[4, 6, 10, 12, 17, 19]报道再次肝切除术组围手术期病死率为1.3%~2.6%,中位值为2%,其余文献报道发生率为0;仅1篇文献[9]报道RFA围手术期病死率为2.2%,其余文献报道发生率为0(表 2)。

    表  2  纳入患者的治疗结局
    第一作者和年份 组别 并发症发生率(%) 围手术期病死率(%) 复发[例(%)] RFS OS
    1年 3年 5年 P1) 1年 3年 5年 P1)
    Wang 2015[3] 肝切除 - - - - - - - 97.7 84.1 64.5 <0.001
    RFA - - - - - - 96.9 73.4 37.0
    Sun 2017[4] 肝切除 16 2 30(69.8) 57.0 32.1 28.6 0.89 97.6 82.7 56.4 0.69
    RFA 7 0 41(71.9) 60.8 26.6 16.6 98.2 77.2 52.6
    Umeda 2011[5] 肝切除 - - - - - - - 93.1 66.8 58.1 0.899
    RFA - - - - - - 94.7 75.1 48.3
    Song 2015[6] 肝切除 64 2.6 18(46.2) 66.1 48.5 43.1 0.834 88.8 88.8 83.9 0.686
    RFA 2.2 0 117(65.7) 70.1 40.8 30.0 98.9 82.5 71.0
    Liang 2008[7] 肝切除 68.2 0 86.4 - - - - 78.6 44.5 27.6 0.79
    RFA 3.0 0 78.8 - - - 76.6 48.6 39.9
    Ho 2012[8] 肝切除 - - - - - - - - - 72.0 -
    RFA - - - - - - - - 83.0
    Chan 2012[9] 肝切除 24.1 0 21(72.4) 41.1 24.2 24.2 0.14 89.7 56.5 35.2 0.51
    RFA 2.2 2.2 38(84.4) 32.2 12.4 9.3 83.7 43.1 29.1
    Chen 2018[10] 肝切除 25 2.1 26(54.2) 73.1 49.7 40.7 0.465 76.3 52.5 42.6 0.413
    RFA 0 0 27(47.4) 69.5 37.8 33.1 78.2 40.8 36.7
    岑峰2016[11] 肝切除 50 0 - 46.4 0 0 - - - - -
    RFA - 0 - 20.8 0 0 - - -
    陈康2019[12] 肝切除 17.1 1.3 - - - - - 88.8 68.8 51.1 0.258
    RFA 9.8 0 - - - - 91.4 73.4 61.1
    黄新辉2013[13] 肝切除 18.1 0 - 43.9 14.4 8.2 0.548 89.5 54.3 28.8 0.780
    RFA 0 0 - 56.9 12.4 5.0 82.6 50.8 20.5
    梁惠宏2011[14] 肝切除 36 0 ≤1年: 39>1年: 33 - - - - 95.3 65.7 54.5 >0.05
    RFA 13 0 ≤1年: 37>1年: 42 - - - 100 79.4 62.1
    任正刚2008[15] 肝切除 5.5 0 ≤2年: 71>2年: 74 79.4 48.1 34.4 0.001 88.1 62.6 41.0 0.693
    RFA 1.5 0 ≤2年: 37>2年: 31 58.0 27.8 12.4 94.7 65.1 37.3
    田正灵2016[16] 肝切除 6.7 0 10(33.3) 73.3 64.3 - 0.002 96.7 93.3 - 0.54
    RFA 3.7 0 24(88.9) 46.7 26.7 - 96.3 84.0 -
    张辉2013[17] 肝切除 15.9 1.45 - - - - - 68.2 45.4 - >0.05
    RFA 0 0 - - - - 73.7 53.6 -
    张婷婷2014[18] 肝切除 - 0 22(56.4) 66.7 50.7 43.4 0.323 96.2 76.9 61.2 0.471
    RFA - 0 14(52.9) 65.8 28.0 14.0 86.2 73.3 62.2
    Peng 2018[19] 肝切除 17.7 1.3 - 64.8 41.6 38.3 0.258 84.8 60.2 51.9 0.871
    RFA 4.7 0 - 58.2 35.2 29.6 84.6 66.9 49.1
    Lu 2020[20] 肝切除 - - - 91.8 82.0 72.9 0.38 - - - -
    RFA - - - 94.4 75.4 61.7 - - -
    Xia 2019[21] 肝切除 22.4 0 60.8 85.0 52.4 36.2 0.09 92.5 65.8 43.6 0.17
    RFA 7.3 0 64.2 74.2 41.7 30.2 87.5 52.5 38.5
    刘嘉龙2019[22] 肝切除 35.9 0 19(48.7) 69.2 - - <0.001 92.3 - - 0.292
    RFA 4.9 0 32(78.0) 26.8 - - 85.4 - -
    注:-,未报道;1) P值来源于原文报道。
    下载: 导出CSV 
    | 显示表格

    共有18篇研究[3-10, 12-18, 21-22]报道了OS(表 2)。两组患者术后1、3、5年中位OS分别为92.3%、66.3%、51.1%与91.4%、69.2%、39.9%。共有14篇研究[3-10, 12, 15, 18-19, 21-22]可提取数据统计HR,各组间不存在异质性(I2=0,P=0.77),采用固定效应模型进行分析。结果显示,两组患者的OS差异无统计学意义(HR= 0.89,95%CI:0.77~1.02,P=0.10)(图 2)。

    图  2  再次肝切除术和RFA治疗复发性肝癌患者OS的比较

    共有13篇研究[4, 6, 9-11, 13, 15-16, 18-19, 20-22]报道了RFS(表 2)。两组患者术后1、3、5年中位RFS分别为67.9%、48.3%、34.4%和57.5%、27.9%、14.0%。共有10篇研究[4, 6, 9-10, 15, 18-22]可提取数据统计HR,各组间不存在异质性(I2=0,P=0.53),采用固定效应模型进行分析。结果显示,再次肝切除术组患者的RFS显著高于RFA组(HR=0.79,95%CI:0.72~0.87,P<0.001)(图 3)。

    图  3  再次肝切除术和RFA治疗复发性肝癌患者RFS的比较

    基于OS和RFS HR的漏斗图提示,发表偏倚不明显(图 4)。

    图  4  再次肝切除术和RFA治疗复发性肝癌患者OS及RFS HR的发表偏倚分析

    肝癌术后复发是影响患者术后长期生存的主要危险因素。对于复发性肝癌,目前临床上以多学科综合治疗为主。肝移植能显著提高复发性肝癌患者的RFS和远期生存率[23],但肝移植适应证严格、肝源匮乏和费用昂贵等问题仍限制其广泛的临床应用。此外,既往研究[24-25]表明再次肝切除术和RFA对复发性肝癌的疗效均优于介入。因此,针对肝内复发性肝癌患者,再次肝切除术和RFA是目前较为理想的治疗方案。有研究[3]认为再次肝切除术是治疗复发性肝癌的首选治疗方案,即使患者的原发癌更具侵袭性,肝功能水平更差,肝癌复发后行再次肝切除术仍可以获得与RFA相似的疗效。梁惠宏等[14]的研究则发现,RFA治疗复发性小肝癌的长期疗效优于再次肝切除术。因此,关于再次肝切除术和RFA治疗复发性肝癌的选择仍存在较大争议。本研究通过Meta分析的方法,综合评估再次肝切除术和RFA治疗复发性肝癌的疗效和安全性。

    本研究结果显示,两组患者的OS无显著性差异,但再次肝切除术组患者的RFS显著高于RFA组。这一结论与肝切除术和RFA治疗原发性肝癌的结果一致[26-27]。RFA组患者RFS偏低的原因可能是:(1)再次肝切除术能将复发肿瘤以及潜在的瘤周子灶及血管癌栓同时切除,减少肿瘤再次局部复发和转移的可能性;(2)RFA后部分患者的肿瘤消融不完全而需进行二次消融或其他治疗;(3)术前影像学检查未能发现主瘤旁的微小卫星灶,导致消融不完全而引起肝癌再次复发。虽然RFA可用于治疗直径≤5 cm的肝癌,但目前认为其最佳适应证为直径≤3 cm的小肝癌[28]。有研究[29]发现,肝癌的直径和数目是导致RFA消融不完全的主要因素,随着肝癌直径的增加,RFA的疗效逐步下降。Livraghi等[30]的研究也表明RFA治疗直径3~5 cm的肝癌时完全消融率显著降低,导致RFA治疗复发性肝癌后局部复发和早期复发的比例明显升高。无论是原发性还是复发性肝癌,肿瘤直径在3~5 cm时经RFA治疗后其RFS和远期生存率均低于再次肝切除术[21, 31]。因此,在选择复发性肝癌治疗方案时,肿瘤直径应作为重要的参考指标。

    本研究中,在围手术期并发症方面,再次肝切除术组和RFA组患者的中位发生率分别为22.4%和3.3%,与原发性肝癌接受肝切除术或RFA治疗后的并发症发生率相似[32-33]。此外,本研究还发现RFA治疗复发性肝癌的安全性明显优于再次肝切除术。RFA组患者术后并发症发生率及严重程度更低。虽然再次肝切除术能改善患者的远期生存率及RFS,但再次肝切除术的实施仍受诸多因素的限制,例如复发肿瘤的位置、数量以及肝硬化严重程度等。手术造成较大的创伤导致患者术后更容易发生严重并发症。此外,肝癌患者常伴有不同程度的肝硬化,无疑增加了手术的风险,部分患者最终死于肝衰竭而非肝癌本身带来的肿瘤负担[32]。相比于再次肝切除术,RFA在超声等影像学技术引导下精准地对复发肿瘤进行消融,从而最大限度地避免正常肝组织的破坏。对于手术无法切除、无法耐受手术的患者亦可选择RFA治疗。此外,RFA还可联合介入或无水酒精注射提高患者的OS和RFS[10, 19]。RFA本身具有微创和可重复的优点,肝癌再次复发后相当一部分患者仍可及时接受RFA或其他治疗[12],从而获得与再次肝切除相似的短期OS。

    值得注意的是,本研究纳入文献中多数为回顾性研究,仅有2篇随机对照试验,因此本研究结论仍需更多的随机对照试验进行验证。其次,再次肝切除术和RFA治疗复发性肝癌的适应证存在一定的区别。然而,本Meta分析纳入的多数文献均仅纳入符合米兰标准的复发性肝癌,这些患者同时符合再次肝切除术和RFA的适应证。最后,肝癌术后复发(甚至多次)比较常见,对于复发肿瘤的治疗,多采取综合治疗方案(如介入、靶向、免疫治疗等),而非再次肝切除术或RFA等“单一”治疗模式。因此,联合治疗方案可能影响本荟萃分析对患者OS的判断。

    总而言之,对于复发性肝癌的治疗,再次肝切除术能提高患者RFS,RFA则具有安全性高的优点。因此,在复发性肝癌患者的治疗中应遵循个体化和多学科治疗原则,合理选择治疗方案。

  • [1]WANG T, LIU S, ZHENG YB, et al.Clinical study on using125Iseeds articles combined with biliary stent implantation in the treatment of malignant obstructive jaundice[J].Anticancer Res, 2017, 37 (8) :4649-4653.
    [2]XU G.Clinical effect of biliary metal stent implantation via endoscopic retrograde cholangiopancreatography in treatment of unresectable malignant extrahepatic biliary obstruction[J].JClin Hepatol, 2018, 34 (2) :337-340. (in Chinese) 徐刚.经内镜逆行胰胆管造影胆道金属支架置入治疗不可切除肝外胆道恶性梗阻的效果观察[J].临床肝胆病杂志, 2018, 34 (2) :337-340.
    [3]CHANG ZK, KOU ZP, LI SX, et al.To evaluate the correlation between the change of immune system function before and after the treatment of malignant obstructive type jaundice treated with biliary stent[J].Eur Rev Med Pharmacol Sci, 2018, 22 (6) :1638-1644.
    [4]PETERSEN BT, KAHALEH M, KOZAREK RA, et al.A multicenter, prospective study of a new fully covered expandable metal biliary stent for the palliative treatment of malignant bile duct obstruction[J].Gastroenterol Res Pract, 2013, 2013:642428.
    [5]LI M, LI K, QI X, et al.Percutaneous transhepatic biliary stent implantation for obstructive jaundice of perihilar cholangiocarcinoma:A prospective study on predictors of stent patency and survival in 92 patients[J].J Vasc Interv Radiol, 2016, 27 (7) :1047-1055.
    [6]NIU H, LI MY.Clinical efficacy of different drainage methods in the treatment of jaundice caused by hilar cholangiocarcinoma[J/CD].Chin J Gastrointest Endosc:Electronic Edition, 2017, 4 (3) :103-108. (in Chinese) 牛宏, 李明阳.不同胆道引流方式治疗肝门部胆管癌所致黄疸的疗效观察[J/CD].中华胃肠内镜电子杂志, 2017, 4 (3) :103-108.
    [7]YU XY, YANG GH, CHEN JM, et al.Effect of parenteral combined with enteral nutrition support therapy on liver function of malignant obstructive jaundice after percutaneous transhepatic cholangial drainage[J].China Med Herald, 2017, 14 (29) :107-110. (in Chinese) 虞向阳, 杨光华, 陈俊卯, 等.肠外联合肠内营养对恶性梗阻性黄疸PTCD术后肝功能指标的影响[J].中国医药导报, 2017, 14 (29) :107-110.
    [8]DU Q, ZHANG FQ, JI G, et al.Efficacy and safety of percutaneous transhepatic biliary stent placement for malignant biliary obstruction[J].J Third Milit Med Univ, 2015, 37 (6) :578-581. (in Chinese) 杜强, 张福庆, 纪刚, 等.经皮肝穿刺胆道支架置入治疗恶性胆道梗阻疗效及安全性分析[J].第三军医大学学报, 2015, 37 (6) :578-581.
    [9]ZHONG J, LIU HT, WANG YH, et al.Clinical effect of percutaneous transhepatic biliary drainage combined with biliary stent placement in treatment of high malignant obstructive jaundice[J].Shandong Med J, 2014, 54 (21) :70-71. (in Chinese) 仲捷, 刘好田, 王彦华, 等.经皮肝穿刺胆道引流术+胆道支架置入术治疗高位恶性梗阻性黄疸疗效观察[J].山东医药, 2014, 54 (21) :70-71.
    [10]WANG WJ, YU CH.Improvement in liver function in patients with malignant obstructive jaundice after endoscopic biliary metallic stent drainage[J].J Clin Hepatol, 2015, 31 (8) :1295-1298. (in Chinese) 王文君, 于聪慧.胆道支架引流术对恶性梗阻性黄疸患者肝功能的影响[J].临床肝胆病杂志, 2015, 31 (8) :1295-1298.
    [11]LI TF, LI Z, HAN XW, et al.Combined T/Y biliary stent placement for the treatment of biliary obstruction caused by BismuthCorlett type IV hilar cholangiocarcinoma[J].Hepatogastroenterology, 2014, 61 (134) :1519-1522.
    [12]LIN Y, ZHU XL, LI X.Treatment and diagnosis of biliary stricture after liver transplantation[J].J Chin Pract Diagn Ther, 2018, 32 (2) :200-204. (in Chinese) 林岩, 朱晓亮, 李汛.肝移植术后胆管狭窄诊疗进展[J].中华实用诊断与治疗杂志, 2018, 32 (2) :200-204.
    [13]WANG LB, WEN F, GUO QY.Postoperative stent restenosis of percutaneous biliary metal stent implantation for malignant obstructive jaundice:Recent progress in clinical research[J].J Intervent Radiol, 2017, 26 (1) :77-81. (in Chinese) 王蓝博, 温锋, 郭启勇.经皮胆道金属支架植入治疗恶性梗阻性黄疸术后支架再狭窄的研究进展[J].介入放射学杂志, 2017, 26 (1) :77-81.
    [14]LEE JJ, HYUN JJ, CHOE JW, et al.Endoscopic biliary stent insertion through specialized duodenal stent for combined malignant biliary and duodenal obstruction facilitated by stent or PTBD guidance[J].Scand J Gastroenterol, 2017, 52 (11) :1258-1262.
    [15]ZHOU G, XIAO EH, SHANG QL, et al.Bare metal stent vs.125I seed stent for the treatment of malignant biliary obstruction:A single-center prospective study[J].J Intervent Radiol, 2018, 27 (5) :467-472. (in Chinese) 周广, 肖恩华, 尚全良, 等.胆道金属裸支架与125I粒子支架治疗恶性胆道梗阻的疗效对比:一项单中心前瞻性研究[J].介入放射学杂志, 2018, 27 (5) :467-472.
    [16]XIE YH, WANG Q, LI R, et al.Clinical efficacy of percutaneous transhepatic biliary drainage parallel intraductal radiofrequency ablation combined with in-traductal stent in the treatment of hilar cholangiocarcinoma with malignant obstruction[J].Clin J Med Offic, 2017, 45 (9) :894-897. (in Chinese) 谢应海, 王琦, 李瑞, 等.经皮肝穿刺胆管腔内射频消融联合植入支架治疗肝门胆管癌伴恶性梗阻临床疗效研究[J].临床军医杂志, 2017, 45 (9) :894-897.
  • Relative Articles

    [1]Jincheng WANG, Peihe YU, Song SU, Bo LI. Clinical effect of endoscopic nasobiliary drainage versus endoscopic biliary stenting in preoperative biliary drainage for low-level malignant obstructive jaundice: A Meta-analysis[J]. Journal of Clinical Hepatology, 2021, 37(4): 863-867. doi: 10.3969/j.issn.1001-5256.2021.04.027
    [2]Peng Lu:Cheng, Shao ZhangFeng, Chen JiaQin, Chen Wei. Effect of aerobic exercise combined with silybin on intestinal mucosal barrier in mice with obstructive jaundice[J]. Journal of Clinical Hepatology, 2020, 36(7): 1577-1583. doi: 10.3969/j.issn.1001-5256.2020.07.025
    [3]Yang DongXiao, Zhang Yong, Wang XueFeng, Li Jiang. Application of ultrasound-guided real-time percutaneous transhepatic-cholangial or transhepatic-cholecyst drainage in treatment of acute obstructive cholangitis in primary hospitals[J]. Journal of Clinical Hepatology, 2020, 36(4): 847-849. doi: 10.3969/j.issn.1001-5256.2020.04.027
    [4]Xu Jian, Zhang Wei, Wu ZhangKang, Wu Guo, Li JingDong. Clinical effect of laparoscopic radical resection in treatment of type Ⅳ hilar cholangiocarcinoma[J]. Journal of Clinical Hepatology, 2019, 35(3): 565-569. doi: 10.3969/j.issn.1001-5256.2019.03.022
    [5]Peng FengHui, Liu Kai, Yang Yang, Liu YaHui, Ji Bo. Biliary stent implantation for malignant obstructive jaundice through the percutaneous transhepatic biliary drainage pathway: A report of 2 cases[J]. Journal of Clinical Hepatology, 2019, 35(7): 1601-1603. doi: 10.3969/j.issn.1001-5256.2019.07.038
    [6]Chen WeiWei, Huang Kun, Liu Rui, Liu ChengLi. Clinical effect of percutaneous transhepatic cholangial drainage combined with biliary stent implantation in treatment of high malignant obstructive jaundice and the influencing factors for prognosis[J]. Journal of Clinical Hepatology, 2019, 35(3): 559-564. doi: 10.3969/j.issn.1001-5256.2019.03.021
    [7]Xu Gang. Clinical effect of biliary metal stent implantation via endoscopic retrograde cholangiopancreatography in treatment of unresectable malignant extrahepatic biliary obstruction[J]. Journal of Clinical Hepatology, 2018, 34(2): 337-340. doi: 10.3969/j.issn.1001-5256.2018.02.023
    [8]Wang DianBei, Zhao LiJin, Tu Kui, Yu Qin. Clinical effect of anatomical hepatectomy in treatment of intrahepatic bile duct stones[J]. Journal of Clinical Hepatology, 2017, 33(1): 102-105. doi: 10.3969/j.issn.1001-5256.2017.01.022
    [9]Li ZhangZheng, Liu QuanDa, Yu HuiJie, Hu WenWei, Li Xue, Liu MingHao. Correlation between serum levels of complement C5a and liver fibrosis markers in patients with obstructive jaundice[J]. Journal of Clinical Hepatology, 2016, 32(3): 495-498. doi: 10.3969/j.issn.1001-5256.2016.03.020
    [10]Pan YaJun, Sun ShaoFu. Predictive value of serum CA19-9 in predicting acute cholangitis in patients with obstructive jaundice[J]. Journal of Clinical Hepatology, 2016, 32(8): 1553-1556. doi: 10.3969/j.issn.1001-5256.2016.08.024
    [11]Jia Lei, Guo YuNing, Guo XiuLi, Wang TianYi, Lu: Dong, Xu YouQing. Value of endoscopic ultrasound and magnetic resonance cholangiopancreatography in diagnosis of obstructive jaundice[J]. Journal of Clinical Hepatology, 2016, 32(9): 1753-1755. doi: 10.3969/j.issn.1001-5256.2016.09.024
    [12]Wen Nuan, Zhu YiXiang, Lu: RenGeng, Kang JiangHui, Han HongJun, Xu HanBin. Expression and significance of UCP-2 in rats with obstructive jaundice and bile flow restoration[J]. Journal of Clinical Hepatology, 2015, 31(1): 88-92. doi: 10.3969/j.issn.1001-5256.2015.01.019
    [13]Chen QiuLian, Wu ShanShan, Liu ChaoHui. Clinical application of preoperative biliary drainage in malignant obstructive jaundice with acute cholangitis[J]. Journal of Clinical Hepatology, 2015, 31(10): 1652-1655. doi: 10.3969/j.issn.1001-5256.2015.10.023
    [14]Wang WenJun, Yu CongHui. Improvement in liver function in patients with malignant obstructive jaundice after endoscopic biliary metallic stent drainage[J]. Journal of Clinical Hepatology, 2015, 31(8): 1295-1298. doi: 10.3969/j.issn.1001-5256.2015.08.027
    [15]Yang ShengHua, Zhang ChengHua, Du LingHong. Relationship between ways of nutritional support and immune function in patients with malignant obstructive jaundice after PTCD[J]. Journal of Clinical Hepatology, 2014, 30(11): 1148-1152. doi: 10.3969/j.issn.1001-5256.2014.11.014
    [16]Wang XiaoPeng, Su He, Tian HongWei, Zhang SuYu, Wu ZiYan, An YaLi, Ma YunTao. Clinical efficacy of magnesium isoglycyrrhizinate in treatment of liver injury among patients with obstructive jaundice after percutaneous transhepatic cholangiodrainage[J]. Journal of Clinical Hepatology, 2014, 30(6): 563-566. doi: 10.3969/j.issn.1001-5256.2014.06.022
    [17]Liang Zhang, Li DeWei. Progress in surgical palliative treatment for malignant obstructive jaundice[J]. Journal of Clinical Hepatology, 2013, 29(6): 467-470.
    [18]Sun YunTao, Ban Bo, Wang YiBo, Liu Yang. Effect of fenofibrate on hepatocyte apoptosis and hepatic glycogen in rats with obstructive jaundice[J]. Journal of Clinical Hepatology, 2011, 27(9): 947-950.
    [19]Zhang ZhenZhong, Chen WuXia, Sun YuanYuan. The clinical analysis on endoscope technique applicated for patients suffering from extrahepatic cholestatic jaundice[J]. Journal of Clinical Hepatology, 2011, 27(9): 918-921.
    [20]Sun YingHao, Xu HongXin, Yu Yang, Wu LiJun.

    Percutaneous biliary drainage tube and stent placement in treatment of malignant obstructive jaundice

    [J]. Journal of Clinical Hepatology, 2010, 26(1): 84-85.
  • Cited by

    Periodical cited type(4)

    1. 卢冰. 再次肝切除术和射频消融术在治疗肝切除术后早期复发性小肝癌中的疗效比较. 医药论坛杂志. 2024(06): 620-623+628 .
    2. 刘明强. 射频消融与肝动脉化疗栓塞术治疗复发性肝癌的效果对比. 中外医疗. 2024(12): 21-24 .
    3. 周亚丹. 围术期预见性护理对肝癌射频消融术患者的影响. 国际医药卫生导报. 2023(05): 708-713 .
    4. 姚加堤. 射频消融术在原发性肝癌术后复发患者中的应用价值. 中外医学研究. 2023(29): 49-52 .

    Other cited types(0)

  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (2175) PDF downloads(317) Cited by(4)
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return