胰腺囊性肿瘤内镜超声引导下聚桂醇消融术的前瞻性研究  

Endoscopic ultrasonography-guided lauromacrogol ablation for pancreatic cystic neoplasms： a prospective study

作　　者：杜晨[1] 柴宁莉[1] 令狐恩强[1] 李惠凯[1] 孙玉发 徐伟 李贞娟[1] 姜蕾[1] 孙丽华 郭旭[1] 杨晶[1] 唐平[1] 王向东[1] 

机构地区：[1]中国人民解放军总医院消化科,北京100853 [2]中央军委联合参谋部警卫局卫生保健处

出　　处：《中华消化内镜杂志》2017年第9期653-657,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜超声（EUS）引导下聚桂醇消融术的安全性及有效性。方法自2015年4月至2017年3月前瞻性纳入于中国人民解放军总医院诊断为胰腺囊性肿瘤（PCNs）并行EUS引导下聚桂醇消融术治疗的患者38例，术中术后观察是否出现胰腺炎、发热、出血、腹痛等不良反应。术后3个月复查胰腺增强CT和（或）MRI，其后间隔6个月、1年、2年复查，观察术后病灶体积。结果38例患者中女性24例，男性14例，平均年龄（53．9±14．7）岁，其中8例行第二次消融，总计消融46例次。46例次消融术后出现2例轻度急性胰腺炎、1例中等度发热，并发症发生率6．5％（3／46）。29例患者完成随访，中位随访时间5个月（2～17个月）。消融术前中位肿瘤体积为7564．40mm^3（301．38～87082．87mm^3），术后体积明显缩小至542．84mm。（0～18202．58mm。）（P=0．000）。29例随访患者中完全缓解14例、部分缓解8例，消融术有效率为48．3％（14／29），其中头颈部病变有效率为40．0％（8／20），体尾部病变有效率为66．7％（6／9），不同部位之间有效率差异无统计学意义（P=0．353）。完全缓解组病变表面积较非完全缓解组小（1194．27mm^3比1764．09mm^3，P=0．023）。结论EUS引导下胰腺囊性肿瘤消融术是安全有效的，表面积较小病变更易获得完全缓解。Objective To evaluate the safety and effectiveness of endoscopic uhrasonography （EUS）-guided ablation with lauromacrogol for pancreatic cystic neoplasms（PCNs）. Methods A total of 38 patients with PCNs admitted to Chinese PLA General Hospital from April 2015 to March 2017 were prospectively enrolled to receive EUS-guided ablation with lauromacrogol. Adverse events, such as pancreatitis, fever, bleeding and abdominal pain, were monitored during and after the procedure. Patients were followed up with contrast-enhanced CT or MRI in 3 months ,6 months, 1 year and 2 year after ablation. Results Thirty-eight patients were enrolled in the study, and 8 of them underwent a second ablation;so, there were 46 treatments. There were 24 females and 14 males with mean age being 53.9＋ 14. 7 years. Mild acute pancreatitis occurred in 2 cases and moderate fever occurred in 1 case. The adverse events rate was 6.5% （3/46）. Among the 29 patients with complete follow-up of 5 months （2-17 months） , the medium tumor volume before operation was 7 564.40 mm^3 （ 301.38-87 082. 87 mm^3 ） while 542. 84 mm^3 （ 0- 18 202. 58 mm^3） after the operation （P = 0. 000）. A total of 14 had complete remission （CR） and 8 had partial remission （PR） in 29 patients. The remission effective rate was 48.3% （ 14/29）, 40. 0% （8/20） in the cysts of the head/uncinate and 66. 7%（6/9） in the body/tail（P= 0. 353）. The medium surface area of CR group seemed smaller than that of non-CR group （ 1 194. 27 mm^2 VS 1 764. 09 mm^2, P = 0. 023 ）. Conclusion EUS-guided ablation with lauromacrogol for PCNs is safe and effective. Cysts of smaller surface are more likely to be cured than larger ones.

关 键 词：胰腺肿瘤 内窥镜检查 超声检查 消融术 聚桂醇 

分 类 号：R735.9[医药卫生—肿瘤]