超声引导经皮纳米刀治疗局部进展期胰腺癌及超声造影评估  

Locally advanced pancreatic cancer： treatment with Nanoknife percutaneously under guidance of ultrasound and effectiveness evaluated by contrast enhanced ultrasonography

作　　者：史秋生[1] 赵京龙[2] 杜联芳[1] 万智勇[3] 李鑫 刘龙[1] 李刚 高康[1] 张焱锋 

机构地区：[1]上海交通大学附属第一人民医院超声医学科,201620 [2]上海交通大学附属第一人民医院放射科,201620 [3]上海交通大学附属第一人民医院肿瘤科,201620

出　　处：《中华超声影像学杂志》2017年第10期877-881,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81571677,81271596）

摘　　要：目的探讨局部进展期胰腺癌（locally advanced pancreatic cancer，LAPC）的纳米刀治疗及超声造影表现。方法收集LAPC患者4例，超声引导经皮植入纳米刀消融针3～5根，消融层面2～3个。治疗后超声造影、增强CT、增强MRI、CT血管造影（computed tomography angiography，CTA）及临床随访评估疗效。结果4例患者治疗后均有可耐受的腹部疼痛不适。1例梗阻黄疸及轻度肝功能损伤患者，治疗后1d胰淀粉酶轻度增高，3dC反应蛋白增高合并胆道感染，7d门静脉和脾静脉血栓。4例患者治疗后生存期为3～8个月。超声造影检查，4例1周内消融区均呈造影无增强、边界清晰锐利；3例1～2个月消融区周边显示斑点状造影增强。增强CT及增强MRI检查，3例1～2个月消融区未见造影剂强化，周边不均匀低增强。CTA检查，1例50d肠系膜上静脉及脾静脉局限狭窄伴侧支循环形成，1例70d肠系膜上静脉堵塞伴侧支循环形成。结论LAPC患者行纳米刀治疗，经皮超声引导操作简便安全。超声造影是评估疗效的有效方法。Objective To explore the treatment of locally advanced pancreatic cancer （LAPC） by Nanoknife,and the demonstrations on contrast enhanced ultrasonography （CEUS） after the procedures. Methods Four patients were enrolled. Each of them was percutaneously inserted 3 - 5 Nanoknife electrodes to ablate the lesions with 2 - 3 sessions under the guidance of ultrasound. After the procedures, CEUS, contrast enhanced CT, contrast enhanced MRI or computed tomography angiography （CTA） were performed to assess the efficacy. Results All patients uneventfully were able to tolerate the high-voltage Nanoknife procedures. However, the endurable pain or discomfort in abdomen was complained. For one patient with obstructive jaundice and mild liver dysfunction, pancreatic amylase in serum increased slightly at the first day after treatment. Furthermore, C response protein in serum elevated, and biliary tract infection happened at the third day. Moreover, thromboses in portal and splenic vein were found at the seventh day. The survival time for all cases were 3 - 8 months. According to the findings of CEUS, a well- defined no contrast enhancement was detected at ablative zone for all the patients within one week. Yet, contrast enhancement was sporadically detected at the periphery in 3 patients 1 - 2 months late. Meanwhile, on contrast enhanced CT or MRI, an area of absent enhancement was also depicted at the ablation zone with heterogeneously decreased enhancement at periphery of the lesion. Base on CTA findings, local stenosis of splenic vein and superior mesenteric vein with varices of collateral vascularity were found in one patient at the fiftieth day, and superior mesenteric vein obstruction accompanied by varices of collateral vascularity was also found in another patient at the seventieth day. Conclusions For patients with LAPC, Nanoknife treatment is a safe and convenient procedure that can be percutaneously completed under the guidance of ultrasound. Along with enhanced CT, MRI or CTA, CEUS is a promising way to ev

关 键 词：超声检查 介入性 超声造影 胰腺肿瘤 纳米刀 电穿孔 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.9[医药卫生—诊断学]