超声内镜引导下聚桂醇消融术治疗胰腺囊性肿瘤安全性及有效性的前瞻性研究  

Prospective study of safety and effectiveness of EUS-guided lauromacrogol ablation for pancreatic cystic neoplasms

作　　者：杜晨[1] 令狐恩强[1] 柴宁莉[1] 李惠凯[1] 李贞娟[1] 杨晶[1] 唐平[1] 王向东[1] 

机构地区：[1]解放军总医院消化科,北京100853

出　　处：《中华胃肠内镜电子杂志》2017年第1期1-5,共5页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：军队课题(14BJZ01)

摘　　要：目的随着影像学诊断技术的进步,胰腺囊性肿瘤(PCNs)的检出率越来越高。外科手术治疗PCNs的并发症发生率和死亡率较高。本文旨在研究一种新的内科微创治疗方法-超声内镜(EUS)引导下聚桂醇消融术治疗胰腺囊性肿瘤的安全性及有效性。方法前瞻性纳入自2015年4月至2015年10月经解放军总医院影像学疑诊PCNs患者65例行EUS检查,18例行EUS引导下聚桂醇消融治疗。术后3个月复查胰腺增强CT及(或)胰腺MRI。消融效果评价采用实体瘤疗效评价标准(RECIST)。结果 18例行EUS引导下聚桂醇消融术患者中2例行第2次消融,共消融20例次。病变位于头颈部13例、体尾部5例。消融术前肿瘤最大直径平均(32.1±16.1)mm,术后最大直径平均(13.0±10.9)mm。20例次消融术后出现2例轻度急性胰腺炎、1例中等度发热,均发生在头颈部消融术后。16例患者完成随访,中位随访时间3.5个月(1.7~10.8个月);其中完全缓解(CR)3例、部分缓解(PR)9例。消融术有效率为75%(12/16),头颈部病变有效率为66.7%(8/12),体尾部病变有效率为100%(4/4),不同部位消融有效率差异无统计学意义(P>0.05)。结论 EUS引导下聚桂醇消融术治疗胰腺囊性肿瘤是安全有效的,头颈部病变并发症发生率较体尾部高,但研究结果仍需大样本、长期随访研究进一步验证。Objective With the development of diagnostic imaging techniques, the detection rate of pancreatic cystic neoplasms （PCNs） has increased. The morbidity and mortality rates of PCNs treated by surgery are quite high. The aim of the present study was to evaluate the safety and effectiveness of a minimally invasive treatment,EUS-guided PCNs ablation with lauromacrogol. Methods From Apr 2015 to Oct 2015 , 65 patients suspected of PCNs were enrolled to perform EUS. We prospectively studied 18 of the 65 patients undergoing EUS-guided ablation with lauromacrogol. The enhanced CT or MRI was conducted at 3 months after ablation during follow-up. The effectiveness of ablation was assessed by Response Evaluation Criteriain Solid Tumors（ RECIST）. Results There were 18 patients enrolled in the study and 2 of them underwent a second ablation,so there were 20 treatments of ablation. There were 13 cysts located in the head/uncinate while 5 in the body/tail. The mean tumor diameter was （ 32. 1 ± 16. 1） mm in pre-operation while （ 13. 0 ± 10. 9） mm in post-operation. Mild acute pancreatitis occurred in 2 treatments and moderate fever occurred in one treatment,which were all occurred in the pancreati chead/uncinate. Among the 16 patients with complete followed-up of 3. 5 months （ rang, 1. 7-10. 8 months）,3 had complete resolution （ CR） and 9 had partial resolution（ PR） . The resolution rate was 75% （ 12/16 ） , 66. 7% （8/12） of the cysts in the head/uncinate and 100% （4/4） in the body/tail（P 〉0.05）. Conclusions EUS-guided PCNs ablation with lauromacrogol is safe and effective. Adverse event rates are higher in the head/uncinate than those in the body/tail. Further studies involving larger samples and longer follow-up are warranted.

关 键 词：聚桂醇 消融术 胰腺囊性肿瘤 超声内镜 

分 类 号：R735.9[医药卫生—肿瘤]