探讨经皮肝穿刺胆道腔内射频消融（RFA）联合支架介入治疗恶性梗阻性黄疸的效果及安全性。

纳入无法行手术切除的恶性梗阻性黄疸患者共13例，均接受经皮肝穿刺胆道腔内RFA联合支架植入术，观察手术并发症、黄疸缓解情况并密切随访术后1、3、6个月的支架畅通情况及生存时间。

所有患者均成功接受手术治疗，术后无胆道穿孔、胆漏、胆汁性腹膜炎等严重并发症发生，术后1周，患者血清总胆红素水平较术前显著降低[（95.4±83.0）μmol/L vs. （196.4±148.4）μmol/L, t=5.156，P<0.01]，黄疸缓解率为61.5%。随访术后1个月、3个月支架通畅率均为100%，6个月支架通畅率为80%（8/10）。1个月存活率为100%（13/13），3个月存活率为92%（12/13），6个月存活率为77%（10/13），其中2例分别于65 d、132 d后死于晚期肿瘤严重消耗，1例97 d后死于弥散性血管内凝血。2例患者在术后4~5个月内黄疸复发，再次行RFA并重新放入金属支架。

联合支架植入治疗在短期内能有效且安全地延长恶性梗阻性黄疸患者胆道支架通畅时间及无症状生存时间，其远期疗效尚需进一步探讨。

To investigate the safety and feasibility of percutaneous intraductal radiofrequency ablation(RFA) plus biliary stenting in the treatment of malignant biliary obstruction.

Thirteen patients with unresectable malignant obstructive jaundice were selected, then underwent percutaneus intraductal radiofrequency ablation plus metallic biliary stent placement. Clinical efficacy was evaluated by observing the operative complications, remission of jaundice, and the stent patency and survival rate at 1,3,6 months were recorded.

All the patients underwent the intraductal RFA . No complications such as perforation, biliary leakage or bile peritonitis occurred. Serum total bilirubin was statistical significantly decreased in 1 week[195.4±83.0)μmol/L vs (196.4±148.4)μmol/L, t=5.156, P<0.01], and the jaundice remission rate was 61.5%. The 1,3 month patency rate was 100%, the 6 month patency rate was 80% (8/10). The 1 month survival rate was 100%, The 3,6 month survival rate was 92% (12/13) and 77% (10/13) respectively. Two patients dead of serious drain with advanced tumors in 65,132 days after operation respectively, and one patient dead of disseminated intravascular coagulation in 97 days. Jaundice recurrence occurred in two patients in 4~5 months after the procedure were controlled after received the interventional treatment again.

Percutaneous intraductal radiofrequency ablation(RFA) can effectively and safely prolong the stent patency and survival time of patients with malignant biliary obstruction, although its long-term efficacy needs to be further proved.