CT引导下经皮纳米刀消融治疗局部晚期胰腺癌相关并发症初步分析  

CT-guided percutaneous irreversible electroporation of locally advanced pancreatic cancer： a complications analysis

作　　者：魏颖恬 肖越勇[1] 张肖[1] 张啸波[1] 何晓锋[1] 张欣[1] 马旭阳[1] 李婕[1] 杨杰[1] Wei Yingtian;Xiao Yueyong;Zhang Xiao;Zhang Xiaobo;He Xiaofeng;Zhang Xin;Ma Xuyang;Li Jie;Yang Jie(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》2018年第7期528-532,共5页Chinese Journal of Radiology

摘　　要：目的探讨CT引导下经皮纳米刀消融治疗局部晚期胰腺癌（LAPC）的相关并发症，为其防治提供指导。 方法回顾性分析2015年7月至2016年6月，我院行CT引导经皮纳米刀消融治疗的LAPC患者（17例，共17个病灶）的临床及影像资料。分析患者术中及术后7 d内及30、90 d的并发症发生与进展情况。采用Clavien-Dindo分级标准进行分级，总结并发症发生的原因，探讨其防治措施。 结果术中2例患者于电脉冲释放时出现一过性心率增快。术后7 d内共11例（65%）患者出现并发症，Ⅰ级并发症6例，为腹痛、恶心呕吐或胰腺周围少许炎性渗出；Ⅱ级并发症4例，为门静脉系统血栓形成；Ⅲa级并发症1例，为腹膜后感染。术后30 d，所有Ⅰ级并发患者症状消失，Ⅱ级并发症患者症状无明显改善，Ⅲa级并发症患者症状有好转；术后90 d，原Ⅲa级并发症患者症状有好转；Ⅱ级并发症患者2例无变化，2例进展为Ⅴ级，并分别于术后82 d及98 d死于消化道出血。 结论CT引导纳米刀消融治疗LAPC是一项安全的消融治疗方式，术前严格患者适应证选择、制定合理的预防及处理措施可减少并发症发生。ObjectiveTo investigate the CT-guided percutaneous irreversible electroporation （IRE） in treating locally advanced pancreatic cancer （LAPC） and providing guidance for its prevention and treatment. MethodsWe retrospectively analyzed the clinical and imaging data of 17 patients （17 lesions） of LAPC treated with CT-guided IRE in our hospital from July 2015 to June 2016. Complications were documented and reviewed at day 7, 30 and 90 follow up as well as during the procedure. The Clavien-Dindo was used for classification. The reasons that induced complications were summarized and to further discuss the prevention and treatment approaches. ResultsOf 17 patients, 2 patients suffered a transient tachycardia during the procedure. Eleven patients （65%） showed complications at day 7, of which grade Ⅰ complications occurred in 6 cases, including abdominal pain, nausea, vomiting, or a few of inflammatory exudations around the pancreas; four patients have grade Ⅱ complications, along with portal vein thrombosis;one patient showed grade Ⅲa complications for retroperitoneal infection. With 30 days follow up, the grade Ⅰ complications disappeared, grade Ⅱ complications have not getting better, while grade Ⅲa complications have been improved. With 90 days follow up, patients with grade Ⅲ a complications getting better;two patients with grade Ⅱ complications didn＇t show any changes; 2 cases progressed to grade Ⅴ, and died of digestive tract bleeding at 82 days and 98 days after procedure. ConclusionCT-guided irreversible electroporation for treating LAPC is a safe ablation approach. Strict patient selection before procedure and make a reasonable prevention and treatment measures can reduce the complications.

关 键 词：胰腺肿瘤 消融技术 纳米刀/不可逆电穿孔 放射学 介入性 

分 类 号：R730.44[医药卫生—肿瘤] R735.9[医药卫生—临床医学]