超声联合CT引导下经皮冷冻治疗胰腺癌85例  

Percutaneous cryoablation for pancreatic cancer with ultrasonography and computed tomography guidance

作　　者：牛立志[1] 何丽华[1] 胡以则[1] 吴炳辉[1] 左建生[1] 徐克成[1] 

机构地区：[1]广州复大肿瘤医院,510305

出　　处：《中华普通外科学文献（电子版）》2011年第5期9-12,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：广东省医学科研基金(WSTJJ20090401440106196602154756)

摘　　要：目的评估超声和CT引导经皮冷冻治疗胰腺癌的安全性及可行性。方法回顾性分析2008年11月至2010年5月在我院接受超声联合CT引导下经皮冷冻治疗的胰腺癌患者85例的临床资料，其中不可切除胰腺癌67例，拒绝手术治疗的可切除性胰腺癌患者18例，共计86个瘤灶接受121次经皮冷冻治疗。依据肿瘤的大小、形状及位置，分别选用1～8根探针。胰头癌采用经腹穿刺，胰体尾癌经腹或经背穿刺的方法。采用两个冷冻一复温循环，冷冻温度为（-160±10）℃，复温温度（25±5）℃，均持续5～10min。于冷冻前后检查CT，评估状态（kamofsky performance status，KPS）评分，观察冷冻治疗后并发症及术后住院时间。结果全组121例次经皮冷冻治疗均顺利完成，无一例死亡。出院时KPS较治疗前提高（P〈0．叭）。冷冻后1～3个月肿瘤平均直径明显缩小[（4．7±0．3）VS．（4．1±0．4），P〈0．01]，所有瘤灶冷冻区活性消失。平均住院时间为（8．0±0．6）d。结论超声联合CT引导经皮冷冻治疗胰腺癌安全可行，具有微创、准确、适形等特点，为临床胰腺癌治疗提供了新的技术手段。Objective To establish the standard technique of percutaneous cryoablaton for pancreatic cancer, assess the safety and feasibility of percutaneous cryoablation with uhrasonography （US） and computed tomography（CT） guidance in the treatment of pancreatic cancer. Methods Areview of 85 cases of pancreatic cancer who underwent cryoablations conducted from November 2008 to May 2010 was observed. Cryocare surgical system and cryoprobes in 1.7 ±2 cm were adopted. One to eight cryoprobes were supplied for each cryoablation. Transabdominal or transdorsal approach was performed for, body and tail of pancreatic cancer, while transabdominal approach for head of pancreatic cancer. Two cycles of fast freezing with argon at （-160 ± 10）℃ for 5 - 10 min and thawing with helium at （15 ±5）℃C for 5 - 10 min were performed for each ablation. CT, karnofsky performance status （KPS）, cryoablation-related complications and hospital length of stay were analyzed. Results One hundred and twenty-one percutaneous cryoablaitons were performed successfully without deaths. Complications were relative infrequent, all of which were controlled well with conventional treatment. All cryolesions presented inactive status after cryoablation, and the average diameter of tumors decreased [ （4.7 ± 0.3） vs. （4.1 ±0.4）, P 〈 0.01 ]. KPS increased [ （80.0± 0.6） vs. （90.0 ±0.4）, P 〈 0.01]. Hospital length of stay was significantly shorter than of intraoperative cryoablations （P 〈 0.05）. Conclusions Percutaneous cryoablation with US and CT guidance is a safe and feasible technique for pancreatic cancer with relatively rare and mild complications and irrefutably ablative effect, which provides an optimistic alternative therapy for pancreatic cancer.

关 键 词：经皮冷冻 超声联合CT引导 胰腺癌 

分 类 号：R735.9[医药卫生—肿瘤]