切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (03) : 230 -233. doi: 10.3877/cma.j.issn.2095-3232.2019.03.012

所属专题： 文献；

临床研究

超声引导下纳米刀治疗不可切除的局部进展期胰腺癌
苏丽娅1, 林满霞1, 陈泽斌2, 谢晓燕1, 匡铭3,†()   
  1. 1. 510080　广州，中山大学附属第一医院介入超声科
    2. 510080　广州，中山大学附属第一医院肝脏外科
    3. 510080　广州，中山大学附属第一医院介入超声科；510080　广州，中山大学附属第一医院肝脏外科
  • 收稿日期:2019-02-18 出版日期:2019-06-10
  • 通信作者: 匡铭
  • 基金资助:
    广东省科技计划项目(2016A020215189); 广州市科技计划-民生科技项目(201704020099)

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

Liya Su1, Manxia Lin1, Zebin Chen2, Xiaoyan Xie1, Ming Kuang3,†()   

  1. 1. Department of Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
    2. Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
    3. Department of Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2019-02-18 Published:2019-06-10
  • Corresponding author: Ming Kuang
  • About author:
    Corresponding author: Kuang Ming, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

苏丽娅, 林满霞, 陈泽斌, 谢晓燕, 匡铭. 超声引导下纳米刀治疗不可切除的局部进展期胰腺癌[J]. 中华肝脏外科手术学电子杂志, 2019, 08(03): 230-233.

Liya Su, Manxia Lin, Zebin Chen, Xiaoyan Xie, Ming Kuang. Ultrasound-guided irreversible electroporation in treatment of unresectable locally advanced pancreatic cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(03): 230-233.

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。

关键词: 胰腺肿瘤, 不可逆电穿孔, 消融技术, 超声检查
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.

Key words: Pancreatic neoplasms, Irreversible electroporation, Ablation techniques, Ultrasonography
表1 15例不可切除的局部进展期胰腺癌患者肿瘤情况
肿瘤情况 例数
肿瘤位置 ?
? 胰头 10
? 胰体 3
? 胰尾 2
血管侵犯 ?
? 腹腔干 6
? 肠系膜上动脉 10
分期 ?
? T4N0M0 7
? T4N1M0 4
? T4NXM0 4
[1]
吉王明，周丁华．胰腺癌的局部消融治疗现状[J]．中国医学工程，2011, 19(4):171-172.
[2]
Wilkowski R,Boeck S,Ostermaier S, et al. Chemoradiotherapy with concurrent gemcitabine and cisplatin with or without sequential chemotherapy with gemcitabine/cisplatin vs chemoradiotherapy with concurrent 5-fluorouracil in patients with locally advanced pancreatic cancer-a multicentre randomised phase Ⅱ study[J]. Br J Cancer, 2009, 101(11):1853-1859.
[3]
Zhang X,Tian J,Zhao L, et al. CT-guided conformal cryoablation for peripheral NSCLC: initial experience[J]. Eur J Radiol, 2012, 81(11):3354-3362.
[4]
周瑜，吴志远，丁晓毅．不可逆电穿孔消融治疗胰腺癌的现状与展望[J/CD]．中华介入放射学电子杂志，2017, 5(3):194-198.
[5]
Zhang Y,Lyu C,Liu Y, et al. Molecular and histological study on the effects of non-thermal irreversible electroporation on the liver[J]. Biochem Biophys Res Commun, 2018, 500(3):665-670.
[6]
Charpentier KP,Wolf F,Nobel L, et al. Irreversible electroporation of the pancreas in swine: a pilot study[J]. HPB, 2010, 12(5):348-351.
[7]
Philips P,Li Y,Li S, et al. Efficacy of irreversible electroporation in human pancreatic adenocarcinoma: advanced murine model[J]. Mol Ther Methods Clin Dev, 2015(2):15001.
[8]
Lin M,Xie X,Xu M, et al. Non-enhanced pattern on contrast-enhanced ultrasound in the local efficacy assessment of irreversible electroporation ablation of pancreatic adenocarcinoma[J]. Ultrasound Med Biol, 2018, 44(9):1986-1995.
[9]
Paiella S,Salvia R,Girelli R, et al. Role of local ablative techniques (radiofrequency ablation and irreversible electroporation) in the treatment of pancreatic cancer[J]. Updates Surg, 2016, 68(3):307-311.
[10]
Rubinsky B,Onik G,Mikus P. Irreversible electroporation: a new ablation modality-clinical implications[J]. Technol Cancer Res Treat, 2007, 6(1):37-48.
[11]
Lee EW,Loh CT,Kee ST. Imaging-guided percutaneous irreversible electroporation: ultrasound and immunohistological correlation[J]. Technol Cancer Res Treat, 2007, 6(4):287-294.
[12]
赵刚．NCCN2017年第2版胰腺癌临床实践指南解读(纳米刀应用之我见)[J]．临床外科杂志，2018, 26(1):25-28.
[13]
牛立志，曾健滢，张怡湜，等．不可逆电穿孔消融治疗胰腺癌的安全性及近期疗效观察[J]．介入放射学杂志，2016, 25(3):225-230.
[14]
林满霞,谢晓燕,匡铭, 等. 超声引导下纳米刀治疗危险部位恶性肿瘤的短期疗效及安全性评价[J]. 中国超声医学杂志, 2017, 33(5): 443-446.
[15]
Martin RC 2nd,Kwon D,Chalikonda S, et al. Treatment of 200 locally advanced (stage Ⅲ) pancreatic adenocarcinoma patients with irreversible electroporation: safety and efficacy[J]. Ann Surg, 2015, 262(3):486-494.
[16]
Martin RC 2nd,McFarland K,Ellis S, et al. Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival[J]. Ann Surg Oncol, 2013，20 Suppl 3: 443-449.
[17]
Martin RC. Irreversible electroporation of locally advanced pancreatic head adenocarcinoma[J]. J Gastrointest Surg, 2013, 17(10):1805-1806.
[18]
Conroy T,Gavoille C,Samalin E, et al. The role of the FOLFIRINOX regimen for advanced pancreatic cancer[J]. Curr Oncol Rep, 2013, 15(2):182-189.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3] 朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 904-910.
[4] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[5] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 974-978.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[8] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[9] 张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 717-721.
[10] 罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[11] 黄佳, 石华, 张玉国, 胡佳琪, 陈茜. 胎儿左头臂静脉正常与异常超声图像特征及其临床意义[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 610-617.
[12] 袁泽, 庄丽. 超声检测胎儿脐动脉和大脑中动脉血流对胎儿宫内窘迫的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 618-621.
[13] 蒋佳纯, 王晓冰, 陈培荣, 许世豪. 血清学指标联合常规超声及超声造影评分诊断原发性干燥综合征的临床价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 622-630.
[14] 廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.
[15] 杨天池, 韩威, 邱枫, 祁佳慧. 术中胰腺超声弹性成像在胰腺质地评估中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 646-650.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号