CT引导不可逆电穿孔消融术治疗局部晚期胰腺癌的有效性和安全性  

CT-guided percutaneous irreversible electroporation for the treatment of locally advanced pancreatic cancer

作　　者：魏颖恬 肖越勇[1] 张肖[1] 何晓锋[1] 张欣[1] 李婕[1] 杨杰[1] 张啸波[1] Wei Yingtian Xiao Yueyong Zhang Xiao He Xiaofeng Zhang Xin Li Jie Yang Jie Zhang Xiaobo(Department of Radiology, PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院放射诊断科,北京100853

出　　处：《中华放射学杂志》2016年第10期789-793,共5页Chinese Journal of Radiology

摘　　要：目的：评价CT引导不可逆电穿孔（IRE）消融术治疗局部晚期胰腺癌的有效性和安全性。方法前瞻性收集经穿刺病理证实的影像表现提示为Ⅲ期胰腺癌患者14例，术前常规行实验室检查和影像检查（CT、MRI、PET-CT等）了解患者的疾病状况。在全身麻醉下行IRE消融术，于CT引导下经皮穿刺置入消融电极，根据肿瘤大小、位置及电极针数目进行消融参数设置，电极针尖端裸露1 cm，消融模式为拔针分段消融。术后第1～3天、1周、1.0个月、3.0个月复查影像及实验室检查，采用改良的WHO实体瘤疗效评价标准评价IRE消融治疗的有效性。观察并发症发生情况。结果14例患者手术均顺利完成。消融完成后即刻行CT增强扫描，消融区均呈低密度坏死改变，无强化，消融边界清晰。术后1周复查CT，14例肿瘤坏死彻底，周围组织结构无破坏。术后1.0个月行CT或MRI显示所有病灶消融区域均呈低密度（信号）改变，增强扫描未见异常强化，周围血管及胰管形态完整。术后胰淀粉酶及CA199一过性升高，而后逐渐降低，术后1周及1.0个月后复查明显降低，癌胚抗原未见明显升高。并发症包括胰周炎性渗出3例、腹膜后感染1例、肠系膜上静脉血栓2例、门静脉主干血栓2例、十二指肠狭窄1例。1例术后2.5个月死于消化道大出血。其余13例于术后3个月评价疗效，完全缓解4例、部分缓解7例、病变稳定2例。结论 CT引导下IRE消融术治疗局部晚期胰腺癌有效、安全。Objective To investigate the safety and efficacy of treatment with CT-guided percutaneous irreversible electroporation （IRE） of locally advanced pancreatic cancer（LAPC）. Methods Patients with unresectable radiographic stage ⅢLAPC were prospectively collected. Comprehensive blood and imaging （CT,MRI,PET-CT） baseline examinations were completed and analyzed preoperatively. Operations were performed under general anesthesia and the needles were inserted under the guidance of CT. Ablative parameters were altered depending on the tumor size, anatomical location, and the number of electrodes. Needle withdrawal combined segmental ablation was chosen and the active electrode exposure length was 1 cm. All the imaging and serological follow-up examinations were performed within 1 to 3 days after procedures, at day 7 postoperatively, 1 and 3 months postoperatively to evaluate the safety and efficacy of IRE（according to modified response evaluation criteria in solid tumours of WHO）. Results All the procedures were completed successfully. Immediately postoperative CT and/or MRI images showed all the ablation areas were well-defined and presented low-density necrosis without enhancement. The CT scans at day 7 postoperatively showed all the 14 lesions were drastically necrotized and the surrounding tissues were unharmed. CT and/or MRI scans at 1 month postoperatively revealed hypodense or low signal ablation areas without enhancement and the peritumoral and involved vessels and pancreatic duct were undamaged. All the patients had a CA199 transient rising, but it decreased progressively within 3 days and then markedly decreased at 1 weak and 1 month postoperatively. The laboratory carcino-embryonic antigen was almost within normal lists. Peripancreatic exudation was noted in 3 cases immediately after the procedures. One patient developed retroperitoneal infection. Mesenteric（2 of 4）and portal（2 of 4）venous thrombosis were＆amp;nbsp;found on MRI images in 4 patients. One patient had a duodenum stenosis

关 键 词：胰腺肿瘤 放射学 介入性 不可逆电穿孔消融 

分 类 号：R735.9[医药卫生—肿瘤]