不可逆电穿孔消融治疗胰腺癌的现状与展望

doi:10.3877/cma.j.issn.2095-5782.2017.03.017

不可逆电穿孔消融（纳米刀）作为一项新兴的介入消融技术，不同于传统的物理消融技术如射频消融、微波消融及冷冻消融等。不可逆电穿孔技术利用高电压脉冲使细胞膜出现纳米级微孔，细胞内环境失衡，最终导致细胞凋亡，但却对细胞外基质影响较小，所以此技术可以应用于邻近重要血管或神经的肿瘤消融。胰腺癌是消化道恶性程度最高的肿瘤之一，预后差且较难早期诊断，往往发现时已经是Ⅲ期或者Ⅳ期。近几年来，不可逆电穿孔消融凭借并发症少、安全性高等优点，逐步应用于不可切除胰腺癌的治疗。本文就不可逆电穿孔消融的基础研究、治疗胰腺癌的临床研究等问题作一综述。

关键词: 不可逆电穿孔, 胰腺癌, 消融, 钠米刀

As an emerging interventional ablation modality which is different from conventional physical ablation such as radiofrequency ablation, microwave ablation and cryoablation, irreversible electroporation(IRE) ablationutilizes high voltage pulses to create permanent nanopores in the cell membrane, which in turn induces apoptosis of targeted cells. The promising technology can be used to ablate tumors adjacent to vital structures due to its less impact on extracellular matrix. Pancreatic cancer, despite extensive research, remains the most aggressive gastrointestinal tumors, having a poor prognosis and ambiguous early symptom usually diagnosed at stage Ⅲ or Ⅳ. Recently, IRE ablation has being progressively applied in the management of unresectable pancreatic cancer by virtue of its high efficiency and safety. This article will review on the basic research of IRE, clinical application in pancreatic cancer and some indefinite questions.

Key words: Irreversible electroporation, Pancreatic Cancer, Ablation, Nanoknife

表1 纳米刀消融治疗胰腺癌的安全性和有效性研究

作者	例数	肿瘤最大径（cm）	术式	中位生存时间（月）	中位无进展生存时间（月）	局部复发率（%）	严重并发症比例*（%）
Scheffer等^[19]	25	4	CT引导经皮消融	17	8	-	47.80
Mansson等^[21]	24	4.5	超声引导经皮消融	17.9	6.1	58.30	25
Yan等^[22]	25	4.2	开放式消融	-	-	-	20
Martin等^[25]	200	2.8	原位消融（150）/边缘消融+切除（50）	23.2/28.3	12.4	29	32/30.6
Narayanan等^[26]	50	4.5	CT引导经皮消融	27	-	-	20
Kluger等^[27]	50	2.7/3.2	原位消融（29）/边缘消融+切除（21）	12.01	-	58	55.20
Belfiore等^[28]	29	-	CT引导经皮消融	14	-	-	-

表1 纳米刀消融治疗胰腺癌的安全性和有效性研究

作者	例数	肿瘤最大径（cm）	术式	中位生存时间（月）	中位无进展生存时间（月）	局部复发率（%）	严重并发症比例*（%）
Scheffer等^[19]	25	4	CT引导经皮消融	17	8	-	47.80
Mansson等^[21]	24	4.5	超声引导经皮消融	17.9	6.1	58.30	25
Yan等^[22]	25	4.2	开放式消融	-	-	-	20
Martin等^[25]	200	2.8	原位消融（150）/边缘消融+切除（50）	23.2/28.3	12.4	29	32/30.6
Narayanan等^[26]	50	4.5	CT引导经皮消融	27	-	-	20
Kluger等^[27]	50	2.7/3.2	原位消融（29）/边缘消融+切除（21）	12.01	-	58	55.20
Belfiore等^[28]	29	-	CT引导经皮消融	14	-	-	-

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