中华胰腺病杂志
中華胰腺病雜誌
중화이선병잡지
CHINESE JOURNAL OF PANCREATOLOGY
2011年
1期
1-4
,共4页
牛立志%李海波%文卫锋%胡勇%吴炳辉%梁冰%李蓉蓉%周亮%王静%杨大明%徐克成
牛立誌%李海波%文衛鋒%鬍勇%吳炳輝%樑冰%李蓉蓉%週亮%王靜%楊大明%徐剋成
우립지%리해파%문위봉%호용%오병휘%량빙%리용용%주량%왕정%양대명%서극성
胰腺肿瘤%冷冻疗法%冷冻消融术%超声成像
胰腺腫瘤%冷凍療法%冷凍消融術%超聲成像
이선종류%냉동요법%냉동소융술%초성성상
Pancreatic neoplasms%Cryotherapy%Cryoablation%Ultrasonography imaging
目的 前瞻性观察经皮冷消融治疗的不良反应、肿瘤变化及近期疗效,探讨该技术治疗局部进展性胰腺癌的可行性.方法 2008年9月至2009年9月共59例局部进展性胰腺癌患者采用氩/氦为基础的冷冻系统,在超声引导下行经皮冷消融治疗.将冷冻探针插入胰腺肿块的中心,做2次循环冷冻,每次冷冻5 min,温度为-160℃,然后复温,持续10 min.检测治疗前和治疗后7 d的血清淀粉酶活性;冷消融后每4～6周行CT扫描评价肿瘤变化;应用Kaplan-Meier法计算生存率.结果 59例患者共有76个活检证实的肿瘤,位于胰头部56个、胰体部7个、胰尾部13个.肿瘤中位大小4.5 cm,19例伴肝转移.术后发生腹痛45例(76.3%),发热29例(49.2%),血淀粉酶升高34例(57.6%),严重并发症(腹腔内出血、胰漏、肠梗阻和冷冻探针针道转移)5例(8.5%),无冷消融相关性死亡.中位住院时间21 d.2例(3.4%)获得完全缓解,23例(39.0%)获得部分缓解,30例(50.8%)疾病稳定,4例(6.8%)疾病进展.中位存活期8.4个月;3、6、12个月存活率分别为89.7%、61.1%和34.5%.结论 超声引导下的经皮冷消融是一种安全可行的局部进展性胰腺癌微创治疗技术.
目的 前瞻性觀察經皮冷消融治療的不良反應、腫瘤變化及近期療效,探討該技術治療跼部進展性胰腺癌的可行性.方法 2008年9月至2009年9月共59例跼部進展性胰腺癌患者採用氬/氦為基礎的冷凍繫統,在超聲引導下行經皮冷消融治療.將冷凍探針插入胰腺腫塊的中心,做2次循環冷凍,每次冷凍5 min,溫度為-160℃,然後複溫,持續10 min.檢測治療前和治療後7 d的血清澱粉酶活性;冷消融後每4～6週行CT掃描評價腫瘤變化;應用Kaplan-Meier法計算生存率.結果 59例患者共有76箇活檢證實的腫瘤,位于胰頭部56箇、胰體部7箇、胰尾部13箇.腫瘤中位大小4.5 cm,19例伴肝轉移.術後髮生腹痛45例(76.3%),髮熱29例(49.2%),血澱粉酶升高34例(57.6%),嚴重併髮癥(腹腔內齣血、胰漏、腸梗阻和冷凍探針針道轉移)5例(8.5%),無冷消融相關性死亡.中位住院時間21 d.2例(3.4%)穫得完全緩解,23例(39.0%)穫得部分緩解,30例(50.8%)疾病穩定,4例(6.8%)疾病進展.中位存活期8.4箇月;3、6、12箇月存活率分彆為89.7%、61.1%和34.5%.結論 超聲引導下的經皮冷消融是一種安全可行的跼部進展性胰腺癌微創治療技術.
목적 전첨성관찰경피랭소융치료적불량반응、종류변화급근기료효,탐토해기술치료국부진전성이선암적가행성.방법 2008년9월지2009년9월공59례국부진전성이선암환자채용아/양위기출적냉동계통,재초성인도하행경피랭소융치료.장냉동탐침삽입이선종괴적중심,주2차순배냉동,매차냉동5 min,온도위-160℃,연후복온,지속10 min.검측치료전화치료후7 d적혈청정분매활성;랭소융후매4～6주행CT소묘평개종류변화;응용Kaplan-Meier법계산생존솔.결과 59례환자공유76개활검증실적종류,위우이두부56개、이체부7개、이미부13개.종류중위대소4.5 cm,19례반간전이.술후발생복통45례(76.3%),발열29례(49.2%),혈정분매승고34례(57.6%),엄중병발증(복강내출혈、이루、장경조화냉동탐침침도전이)5례(8.5%),무랭소융상관성사망.중위주원시간21 d.2례(3.4%)획득완전완해,23례(39.0%)획득부분완해,30례(50.8%)질병은정,4례(6.8%)질병진전.중위존활기8.4개월;3、6、12개월존활솔분별위89.7%、61.1%화34.5%.결론 초성인도하적경피랭소융시일충안전가행적국부진전성이선암미창치료기술.
Objective To observe the adverse reaction, tumor response and short term outcomes of percutaneous cryoablation for locally advanced pancreatic cancer, and investigate its feasibility. Methods Fifty-nine consecutive patients with locally advanced, unresectable pancreatic cancer underwent percutaneous cryoablation at our hospital from Sept. 2008 to Sept. 2009, were prospectively studied. Percutaneous cryoablation was performed with an argon/helium-based cryosurgical system under the guidance of ultrasound.Freezing probe was inserted into the center of pancreatic mass and two cycles of freezing were performed with each cycle for 5 min and temperature at-160℃, then the temperature was returned to normal for 10 min.Serum amylase was detected before operation and 1 to 7 days postoperatively. CT or PET-CT scanning was performed for evaluation of tumor response every 4 to 6 weeks after cryoablation. Survival was assessed by Kaplan-Meier method. Results 59 patients had a total of 76 biopsy-proven tumors, which were located at the pancreas head (n = 56), body (n = 7), and tail (n = 13). The median size of tumor was 4.5 cm (range 3 ～6 cm). Nineteen patients had liver metastases. Postoperative abdominal pain occurred in 45 cases (76.3%),fever occurred in 29 cases (49.2%) and elevation of serum amylase occurred in 34 cases (57.6%). Severe complications including intra-abdominal bleeding, pancreatic leaks, ileus, and metastasis by probe tract occurred in 5 cases (8.5%). There was no death associated with cryoablation. The median hospital stay was 21 days. 2 patients (3.4%) achieved complete response, 23 patients (39.0%) achieved partial response,30patients (50.8%) had stable disease, 4 patients(6.8%) had progressive disease. The median survival was 8.4 months. The overall survival at 3, 6 and 12 months was 89.7%, 61.1% and 34.5%, respectively.Conclusions Ultrasound-guided percutaneous cryoablation appears to be a safe and feasible, minimally invasive technique for locally advanced pancreatic cancer.
