超声引导下纳米刀治疗不可切除的局部进展期胰腺癌  

Ultrasound-guided irreversible electroporation in treatment of unresectable locally advanced pancreatic cancer

作　　者：苏丽娅[1] 林满霞[1] 陈泽斌[2] 谢晓燕[1] 匡铭[1,2] Su Liya;Lin Manxia;Chen Zebin;Xie Xiaoyan;Kuang Ming(Department of InterventionalUltrasound,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou510080,China;Department of Liver Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou510080,China)

机构地区：[1]中山大学附属第一医院介入超声科,广州510080 [2]中山大学附属第一医院肝脏外科,广州510080

出　　处：《中华肝脏外科手术学电子杂志》2019年第3期230-233,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2016A020215189);广州市科技计划-民生科技项目(201704020099)

摘　　要：目的评估超声引导下纳米刀消融技术在治疗不可切除的局部进展期胰腺癌(LAPC中的安全性及有效性。方法回顾性分析2015年9月至2016年5月在中山大学附属第一医院就诊的15例不可切除的LAPC患者临床资料。其中男9例,女6例;年龄34～75岁,中位年龄61岁。肿瘤直径2.1～7.2 cm,中位直径4.4 cm。患者均签署知情同意书,符合医学伦理学规定。患者均接受超声引导下开腹纳米刀消融治疗。观察术中、术后的消融效果,围手术期并发症及生存情况。结果所有患者均顺利完成手术,术中超声评估消融效果满意。术后1 d胰腺超声造影检查显示所有患者的肿瘤均完全消融,未见周围血管、胰管、胆管、肠道等组织结构严重损伤。术后轻度发热2例,疼痛2例,胃肠道不适3例,感染1例,胆管炎1例,均对症治疗后痊愈。术后平均住院时间(12±4) d。患者中位生存期为10个月,生存时间>1年者5例,其中3例接受术后化疗。结论超声引导下纳米刀消融技术治疗不可切除的LAPC是一种安全、有效的治疗方法,相比传统手术具有治疗周期短、并发症少、恢复快等优点。纳米刀消融术后联合化疗可改善患者预后。Objective To evaluate the safety and efficacy of ultrasound-guided irreversible electroporation (IRE) in the treatment of unresectable locally advanced pancreatic cancer (LAPC). Methods Clinical data of 15 patients with unresectable LAPC admitted to the First Affiliated Hospital of Sun Yat-sen University from September 2015 to May 2016 were retrospectively analyzed. Among them, 9 patients were male and 6 female, aged 34-75 years with a median age of 61 years. The tumor diameter was ranged from 2.1 to 7.2 cm with a median of 4.4 cm. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients received ultrasound-guided laparotomy IRE. The intra- and post-operative ablation effect, perioperative complications and survival of the patients were observed. Results All the patients underwent the operation successfully, and the ablation effect was satisfactory evaluated by intraoperative ultrasound. Contrast-enhanced ultrasound of the pancreas at postoperative 1 d demonstrated that tumors of all the patients were ablated completely, and no severe injuries were observed in the peripheral vessels, pancreatic duct, bile duct, intestinal tract and other tissues. 2 cases developed mild fever, 2 cases of pain, 3 cases of gastrointestinal discomfort, 1 case of infection and 1 case of cholangitis were observed after operation. All were cured with symptomatic treatments. The average postoperative length of hospital stay was (12±4) d. The median survival was 10 months. 5 patients survived for over 1 year, 3 of whom received chemotherapy after operation. Conclusions Ultrasound-guided IRE is a safe and efficacious treatment for unresectable LAPC. Compared with the traditional operations, it has the advantages of shorter treatment period, less postoperative complications and faster recovery, etc. IRE combined with postoperative chemotherapy can improve the clinical prognosis of patients.

关 键 词：胰腺肿瘤 不可逆电穿孔 消融技术 超声检查 

分 类 号：R735.9[医药卫生—肿瘤]