腹腔镜下射频消融治疗进展期胰腺癌的疗效评价及安全性分析  

Clinical efficacy assessment and safety analysis of laparoscopic radiofrequency ablation in the treatment ofadvanced-stagepancreaticcarcinoma

作　　者：郑强[1] 薛平[1] 卢海武[1] 曹良启[1] 温子龙[1] 

机构地区：[1]广州医学院第二附属医院肝胆胰外科,510260

出　　处：《中华生物医学工程杂志》2012年第3期219-222,共4页Chinese Journal of Biomedical Engineering

基　　金：广东省科技计划项目（2010B031600141）

摘　　要：目的探讨进展期胰腺癌在腹腔镜下行射频消融的有效性及安全性。方法回顾分析本院2008年4月至2011年5月21例进展期胰腺癌患者进行胰腺癌射频消融治疗后的疗效指标。应用口诉言词评分法（VRS）评价患者疼痛缓解程度。检查术后1d和7d血清总胆红素、术后7d和30d CA19-9水平。观察患者体温等生命体征、腹腔引流液、血淀粉酶、腹部症状等并发症指标。应用B超术后复查肿瘤复发情况，随访观察患者术后生存期。结果与术前相比，所有患者术后疼痛均有不同程度缓解，术前0～1级2例，2～3级19例，而术后0—1级17例，2～3级4例，差异有统计学意义（P〈0．05）。术后血清总胆红素、CA19-9水平较术前明显下降，术后第7天总胆红素下降至（103．23±22．34）μmol／L、术后第30天CA19-9下降至（170．71±95．64）U／ml（均P〈0．05）。患者术后体温有短暂升高，经治疗后均降至正常。腹腔引流液术后第1天最多，为10—180ml，其后日渐减少。术后第1天8例患者出现血淀粉酶一过性升高，术后7d血淀粉酶为（121．52±62．96）U／ml，与术前水平（110．80±51．85）U／ml比较差异无统计学意义。未发现腹腔内出血、腹腔脓肿、胃肠烧灼穿孔、胆漏及肠系膜血栓形成等并发症。术后30d复查B超提示15例完全消融，6例病灶有残留，平均生存期（11±3）个月。结论腹腔镜下射频消融可有效改善进展期胰腺癌患者的镇痛、褪黄效果，延长生存期，具有微创、安全的优势。Objective To investigate the efficacy and safety of laparoscopic radiofrequency ablation （LRFA） in the treatment of advanced-stage pancreatic carcinoma. Methods Between April 2008 and May 2011, the clinical efficacy indications were retrospectively analyzed in 21 patients with advanced- stage pancreatic carcinoma after LRFA treatment. Verbalratingscales （VRS） was used to evaluate the alleviation degree of pain. The postoperative serum total bilirubin was detected at day 1 and day 7 and postoperative CA19-9 level at day 7 and day 30. Moreover, the vital signs （such as body temperature） , complications, peritoneal drainage, serum amylase and abdominal symptom were observed. B ultrasound were used to reexamine the recurrence of tumor after surgery. A following-up was done in patients in order to observe the postoperative survival period. Results The pain after surgery was alleviated in all the patients to different degrees as compared with that before surgery （preoperation 0-1： n=2; 2-3：n=19 vs postoperation 0-1 ： n=17; 2-3： n=4） （P〈0.05）. Both serum total bilirubin and CA19-9 were significantly decreased after surgery, with total bilirubin （103.23±22.34）μmol/L at day 7 and CA19-9 （170.71±95.64） U/ml at day 30 after surgery （all P〈0.05）. After surgery, the body temperatures were briefly elevated in patients, which were all decreased to normal after treatment. The peritoneal drainage liquid was most at day 1 after surgery （ranging from 10-180 ml） but gradually reduced at day 3. Eight patients were found transient increase of serum amylase at day 1 after surgery, with serum amylase（ 121.52±62.96）U/ml at day 7 after surgery , whose amylase preoperation was （110.80±51.85） U/ml （P〈0.05）. No complication was found, such as intraperitoneal bleeding, abdominal abscess, gastrointestinal burning perforation, bile leakage and mesenteric venous thrombosis. The B ultrasound showed the total ablation in 15 cases and residual lesions in 6 cases. Mean survival perio

关 键 词：腹腔镜 消融技术 胰腺肿瘤 疗效比较研究 安全性分析 

分 类 号：R735.9[医药卫生—肿瘤]