摘要
目的:分析评估术中冷冻消融技术治疗局部进展期胰腺癌的近期疗效及安全性。方法:回顾性分析2017年1月—2018年10月南京医科大学第二附属医院胰腺中心收治的30例接受术中冷冻消融治疗的局部进展期胰腺癌患者临床资料,通过总结手术方法,对照分析手术前后肿瘤指标、影像学表现、免疫指标及疼痛评分等参数,统计围手术期并发症率,评估该技术的有效性和安全性。结果:所有患者手术顺利,肿瘤平均大小(4.62±1.49)cm,均为局部进展期胰腺癌(AJCC标准Ⅱb期4例,Ⅲ期26例),平均手术时间(124.0±21.8)min;术后发生胰瘘8例(26.7%),其中A级瘘7例,B级瘘1例,发生胃排空延迟7例(23.3%);术后2周监测CA19-9水平持续下降(P <0.05),疼痛评分较术前明显降低(P <0.01),血清免疫学指标在术后1周上升达到峰值(P <0.01),术后2周回落,术后复查CT显示肿瘤体积有所减小。结论:术中冷冻消融治疗局部进展期胰腺癌安全有效,症状缓解率较高,进一步将冷冻消融的手术策略规范化,可使胰腺癌的局部消融治疗更精准,风险最小化。
Objective:To evaluate the short-term efficacy and safety of Intraoperative cryoablation therapy(IOCT)in the treatment of locally advanced pancreatic cancer.Methods:The clinical data of 30 patients with locally advanced pancreatic cancer who underwent IOCT were analyzed retrospectively from January 2017 to October 2018.The following parameters were collected before and after the operation to assess the effectiveness and the safety of the procedure:tumor markers,clinical images,immunological markers,pain score and the rate of perioperative complications.Results:All the patients underwent a safe operation and the average tumor size was(4.62±1.49)cm,all of which were locally advanced pancreatic cancer(4 cases of stageⅡb and 26 cases of stageⅢaccording the AJCC standard).The average operation time was(124.0±21.8)min.There were 8 cases of pancreatic fistula(26.7%),including 7 cases of grade A fistula and 1 case of grade B fistula.7 cases had gastric emptying obstruction(23.3%),and there was a sustained decrease in CA19-9 level at 2 weeks after the operation(P<0.05).The pain score was significantly lower than that before the operation(P<0.01).Serum immunological markers increased to peak 1 week post-operatively(P<0.01),and returned to normal after 2 weeks.CT showed that the size of the tumor had decreased(P=0.054).Conclusion:intraoperative argon-helium cryoablation is safe and effective in the treatment of locally advanced pancreatic cancer.The rate of remission is high.Therefore,further standardization of the technique can improve the accuracy of the local ablation of pancreatic cancer and can minimize complications.
作者
张彬
杨晓俊
顾玉青
杨桂元
吴迎春
李亚男
钱祝银
Zhang Bin;Yang Xiaojun;Gu Yuqing;Yang Guiyuan;Wu Yingchun;Li Yanan;Qian Zhuyin(Pancreas Center,,the 2nd Affiliated Hospital of Nanjing Medical University,Nanjing 210023,China;Department of Ultrasound,the 2nd Affiliated Hospital of Nanjing Medical University,Nanjing 210023,China)
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2019年第5期689-694,共6页
Journal of Nanjing Medical University(Natural Sciences)
基金
南京市卫生科技发展专项资金项目一般性课题(YKK18188)
关键词
术中冷冻消融
氩氦刀
局部进展期胰腺癌
冷冻免疫
intraoperative cryoablation
argon-helium knife
locally advanced pancreatic cancer
cryo-immunology
