悪性胆道閉塞に対する内視鏡的マイクロ波凝固治療：腸管長期開存の工夫

概要

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Recently, endoscopic stenting for the malignant biliary obstruction have contributed to improvement in quality of life (QOL) patients with unresectable pancreato-biliary carcinoma. However, the early occulusion of the stent, due to a bile encrustation, the tumor ingrowth and overgrowth are a major prognostic factor in patients under palliative treatment. In the attempt to prolong the patency of the bile duct, we performed endoscopic microwave coagulation therapy (EMCT) for the malignant biliary obstruction.There were 26 cases (13 men, 13 women ; mean age 72 years, range 30 to 96 years) including 20 of bile duct carcinoma, 2 cases of the carcinoma of the Vater papilla and 2 cases of the recurrence of the post operative biliary tract carcinoma. The microwave irradiation of 50 W/10-second or 40 W/15-second was delivered to the carcinoma under cholangioscopy or duodenoscopy.There were no severe complications associated with this procedure. The long-term patency (mean 18 months) of the biliary obstruction was achieved in all cases after the treatment ; An 1 year-patency rate were 38.5%. There out of 19 cases (73%) survived for more than one year without jaundice. The EMCT has a beneficial effect on maintaining patency of the bile duct for the treatment of malignant biliary obstruction, resulting in prolonging the patient survival.