纳米刀消融治疗不可切除肝门部胆管癌的初步探索  

Preliminary study on the ablation of unresectable hilar cholangiocarcinoma with nano-knife ablation

作　　者：陈艳军[1] 程冰冰[1] 郜宇[1] 陈升阳[1] 周百中[1] 李晓勇[1] CHEN Yan-jun;CHENG Bing-bing;GAO Yu;CHEN Sheng-yang;ZHOU Bai-zhong;LI Xiao-yong(Department of Hepatopancreatobiliary Surgery,the Fifth Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院肝胆胰外科,河南郑州450052

出　　处：《中国现代普通外科进展》2020年第4期267-271,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:分析纳米刀消融治疗不可切除肝门部胆管癌的疗效与难点。方法:回顾性分析2016年1月—2018年6月郑州大学第五附属医院采用纳米刀消融技术治疗的26例不可切除肝门部胆管癌的临床资料。结果:全部患者顺利实施开腹纳米刀消融治疗。4例患者术中放置T管引流,11例术中放置胆道支架,4例术中放置胆道支架+放射性粒子链。8例手术前、后CA19-9均无明显升高;其余18例患者术前CA19-9明显升高,术后第1、3天进一步升高,后逐步下降。术后胆道出血1例,心房颤动2例,上消化道出血死亡1例,胆道感染3例,肝脓肿、腹腔脓肿、淋巴漏各1例,PTCD管脱落4例。22例(84.6%)患者术后胆管再通。26例患者总生存时间平均为(9.8±5.6)个月。结论:纳米刀消融治疗不可切除肝门部胆管癌安全、有效,联合胆道支架治疗可使患者获得更好疗效。Objective:To analyze the efficacy and difficulty of nano-knife ablation in the treatment of unresectable hilar cholangiocarcinoma.Methods:26 patients with unresectable hilar cholangiocarcinoma received nano-knife ablation treatment from Jan 2016 to June 2018.The clinical variables of the patients before and after operation were analyzed.Results:All patients were successfully treated with nano-knife ablation.4 patients were treated with T tube drainage,11 with biliary stent,and 4 with biliary stent and radioactive particle chain.There was no significant increase of ca19-9 in 8 patients before and after surgery,and the remaining 18 patients had significant increase of ca19-9 before surgery,which was further increased on the first and third days after surgery,and then gradually decreased.There were 1 case of biliary hemorrhage,2 cases of atrial fibrillation,1 case of death from upper gastrointestinal bleeding,3 cases of biliary tract infection,1 case of liver abscess,1 case of abdominal abscess,1 case of lymphatic leakage,and 4 cases of PTCD tube shedding.Bile duct recanalized in 22 patients(84.6%).The mean total survival time of 26 patients was(9.8±5.6)months.Conclusion:Nano-knife ablation is safe and effective in the treatment of unresectable hilar cholangiocarcinoma.Combined with biliary stenting,patients can achieve better results.

关 键 词：胆管癌 肝门部 不可切除 纳米刀消融 胆道支架 

分 类 号：R735.8[医药卫生—肿瘤]