CAJ | 학술논문

目的回顾性总结胆管细胞癌胆肠吻合术后肝内转移灶经微波消融后的并发症和预后.方法 2008年2月至2011年10月,解放军总医院6例患者肝内10个转移性胆管细胞癌经微波消融治疗,患者男5例、女l例,年龄52 ～63(58±6)岁,肿瘤大小1.5～3.6(3.3±1.3) cm.所有患者原发病变均位于肝外并曾行手术切除和胆肠吻合术,其中4例患者微波消融前有肝内胆管扩张和积气.结果所有10个转移灶均完全消融,其中4例患者的5个消融灶术后发生脓肿(5/10),并有窦道形成.3例患者经抗炎、置管引流和对症支持治疗后治愈,1例患者术后13 d死亡.随访期内(13 d～37个月)1、2、3年生存率分别为64.8％、21.6％、21.0％(中位生存期,15.7个月).结论微波消融胆肠吻合术后肝内转移性胆管细胞癌具有很高的技术有效率,但肝脓肿的发生率很高,明确原因有利于预防和发生后的及时处置.
목적 회고성총결담관세포암담장문합술후간내전이조경미파소융후적병발증화예후.방법 2008년2월지2011년10월,해방군총의원6례환자간내10개전이성담관세포암경미파소융치료,환자남5례、녀l례,년령52 ～63(58±6)세,종류대소1.5～3.6(3.3±1.3) cm.소유환자원발병변균위우간외병증행수술절제화담장문합술,기중4례환자미파소융전유간내담관확장화적기.결과 소유10개전이조균완전소융,기중4례환자적5개소융조술후발생농종(5/10),병유두도형성.3례환자경항염、치관인류화대증지지치료후치유,1례환자술후13 d사망.수방기내(13 d～37개월)1、2、3년생존솔분별위64.8％、21.6％、21.0％(중위생존기,15.7개월).결론 미파소융담장문합술후간내전이성담관세포암구유흔고적기술유효솔,단간농종적발생솔흔고,명학원인유리우예방화발생후적급시처치.
Objective To explore the complications and clinical outcome of liver metastatic cholangiocarcinoma after microwave ablation (MWA) in patients with a history of pancreatoduodenectomy or liver resection with bilioenteric anastomosis.Methods Retrospective study was made on 10 lesions of intrahepatic metastatic cholangiocarcinoma undergoing MWA (range:1.5-3.6 cm,mean:3.3 ± 1.3 cm) in 6 patients (5 males and 1 female) from February 2008 to October 2011.All had a history of surgical resection for primary neoplasm and bilioenteric anastomosis.Four cases had intrahepatic biliary dilatation pneumatosis.Results All lesions were completely ablated according to the results of contrast-enhanced ultrasound (CEUS) or contrast-enhanced computed tomography/magnetic resonance imaging (CT/MRI) at Month 1 post-MWA.Liver abscess and fistula occurred in 5 ablation zones (5/10) of 4 patients.Three cases were satisfactorily cured with antibiotic dosing,catheter drainage and supportive care.One case died 13 days after MWA.The overall 1,2,3-year survival rates of were 64.8％,21.6％ and 21.0％ respectively (median:15.7 months).Conclusion A high technical success rate of MWA is obtained in the treatment of intrahepatic metastatic cholangiocarcinoma with bilioenteric anastomosis.However,the incidence of abscess formation remains high due to a coexistence of multiple risk factors.