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Первый опыт применения эндоскопической радиочастотной абляции при опухолевом стенозе внепеченочных желчных протоков

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   Цель. Оценка технических особенностей, безопасности и эффективности радиочастотной абляции при опухолевых стриктурах внепеченочных желчных протоков.   Материал и методы. В продолжающееся проспективное наблюдательное исследование с сентября 2022 г. по июнь 2023 г. были включены пациенты с нерезектабельными опухолями внепеченочных желчных протоков. Для обследования выполняли ЭГДС, эндо-УЗИ, ретроградную холангиопанкреатикографию и видеохоледохоскопию с биопсией. В качестве основного метода лечения впервые в России применили протоковую радиочастотную абляцию с установкой полимерного или саморасширяющегося металлического стента.   Результаты. У 3 (75 %) больных диагностирована холангиокарцинома стадии IIb–IIIa, в 1 наблюдении – муцинозная кистозная опухоль с признаками тяжелой интраэпителиальной неоплазии. Радиочастотная абляция всем больным проведена успешно: опухолевый стеноз был полностью устранен, осложнений в ближайшем и отдаленном периоде не было. Медиана наблюдения составила 8 мес.   Заключение. Результаты первого применения протоковой радиочастотной абляции при нерезектабельных опухолях внепеченочных желчных протоков со стенозом представляются положительными. Метод является эффективным, мини-инвазивным и безопасным.

Ключевые слова:
радиочастотная абляция, паллиативное лечение, рак поджелудочной железы, холангиокарцинома, муцинозная кистозная опухоль, опухолевая стриктура, желчные протоки, radiofrequency ablation, palliative treatment, pancreatic cancer, cholangiocarcinoma, mucinous cystic tumor, tumor stricture, bile ducts

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First experience of endoscopic radiofrequency ablation in tumor-induced stenosis of extrahepatic bile ducts

   Aim. To evaluate technical features, safety and efficiency of radiofrequency ablation in tumor strictures of extrahepatic bile ducts.   Materials and methods. An ongoing prospective observational study from September 2022 to June 2023 enrolled patients with unresectable extrahepatic bile duct tumors. Examination involved esophagogastroduodenoscopy, endoscopic ultrasound, retrograde cholangiopancreatography and video choledochoscopy with biopsy. Ductalradiofrequency ablation with polymeric or self-expanding metallic stent placement was applied as the main treatment method for the first time in Russia.   Results. 3 patients (75 %) were diagnosed with cholangiocarcinoma of stage IIb–IIIa, 1 patient – with mucinous cystic tumor with signs of severe intraepithelial neoplasia. Radiofrequency ablation was successfully performed in all patients: tumor stenosis was completely eliminated, no complications reported in the immediate and distant period. The median follow-up period amounted to 8 months.   Conclusion. The results of the first application of ductal radiofrequency ablation in unresectable tumors of extrahepatic bile ducts with stenosis prove to be positive. The method is considered to be effective, minimally invasive and safe.

Keywords:
радиочастотная абляция, паллиативное лечение, рак поджелудочной железы, холангиокарцинома, муцинозная кистозная опухоль, опухолевая стриктура, желчные протоки, radiofrequency ablation, palliative treatment, pancreatic cancer, cholangiocarcinoma, mucinous cystic tumor, tumor stricture, bile ducts