摘要目的 探讨经内镜鼻胆管引流术(endoscopic nasobiliary drainage,ENBD)灌注冷却液在近肝门部肝癌经皮微波消融(percutaneous microwave ablation,PMWA)中防止胆管热损伤的作用.方法 2013年9月至2015年5月,前瞻性纳入20例因近肝门部肝癌行经皮肝穿刺肝癌微波消融的患者.共20个病灶靠近肝门部主胆管,先经ERCP留置ENBD管于肿瘤旁胆管,向ENBD管内快速持续灌注4℃生理盐水,再在超声引导下行PMWA治疗.术后观察是否有胆管热损伤并发症及肝癌原位复发情况.结果 平均随访8.0个月,20例患者均无手术相关性死亡,其中19例(95％)患者无胆管热损伤,1例(5％)患者出现术后胆汁瘤;2例(10％)患者ERCP乳头切开后出血,3例(15％)患者ERCP后出现轻度急性胰腺炎.19例(95％)患者肝癌无原位复发,1例(5％)局部复发再行消融后病灶完全坏死.结论 近肝门部肝癌根治性微波消融中,经ENBD灌注冷却液是防止胆管热损伤安全、有效的方法.

abstractsObjective To evaluate the effectiveness of ENBD tube intraductal cooling technique in preventing bile thermal injury complications caused by percutaneous microwave ablation(PMWA) for hepatocellular carcinomas adjacent to central bile duct.Methods Between September 2013 and May 2015,20 consecutive patients with hepatocellular carcinomas were enrolled in this prospective study.The 20 nodules were close to major bile ducts.An ENBD tube in the hepatic duct was first placed close to the lesion,then 4℃ chilled saline solution was infused via the ENBD tube to prevent heat damage during PMWA.Biliary complications and local tumor recurrence were evaluated after the operation.Results The average follow-up was 8.0 months.There were no ENBD-related or PMWA-related mortality.Bile duct complications did not happen in 19 cases (95％),and 1 case (5％) presented biloma.Two cases (10％) suffered hemorrhage after incised vater papilla,3 cases (15％) suffered acute pancreatitis.Nineteen cases (95％) had no local recurrence of hepatocellular carcinoma,and complete necrosis occurred in 1 case (5％) with local recurrence tumor after second PMWA.Conclusion Cooling of bile ducts via an ENBD tube is a safe and effective measure to prevent bile duct injury by PMWA of HCC close to major bile ducts.