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中华介入放射学电子杂志 ›› 2019, Vol. 07 ›› Issue (01) : 64 -69. doi: 10.3877/cma.j.issn.2095-5782.2019.01.013

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肿瘤介入

超声引导下经皮激光消融治疗进展期胰腺癌的临床研究
安超1, 梁萍1,(), 于杰1,()   
  1. 1. 100853 北京,中国人民解放军总医院介入超声科
  • 收稿日期:2018-12-01 出版日期:2019-02-01
  • 通信作者: 梁萍, 于杰
  • 基金资助:
    国家自然科学基金(81430039、81627803、81801723)

Clinical research on ultrasound-guided percutaneous laser ablation for advanced pancreatic cancer

Chao An1, Ping Liang1,(), Jie Yu1,()   

  1. 1. Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
引用本文:

安超, 梁萍, 于杰. 超声引导下经皮激光消融治疗进展期胰腺癌的临床研究[J/OL]. 中华介入放射学电子杂志, 2019, 07(01): 64-69.

Chao An, Ping Liang, Jie Yu. Clinical research on ultrasound-guided percutaneous laser ablation for advanced pancreatic cancer[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2019, 07(01): 64-69.

目的:

探讨超声引导下经皮激光消融治疗进展期胰腺癌的可行性、安全性和近期疗效。

方法:

研究采用前瞻性研究,选取2016年9月至2017年10月入住我院的7例进展期胰腺癌患者,于超声引导下采用经皮激光消融方法对其进行治疗,比较患者实施激光消融前后的实验室指标(CA-199、血清脂肪酶、淀粉酶和血糖),疼痛及生活质量评分,观察术后消融相关不良反应和主要并发症。

结果:

所有患者均成功完成激光消融术,技术成功率100%。行激光消融术前与术后的CA-199、血清脂肪酶、淀粉酶和血糖水平差异无统计学意义(P均>0.05)。患者术后1个月的躯体功能较术前改善[(50.0±0)分vs. (30.8±3.4)分],疼痛较术前缓解[(26.7±11.3)分vs.(61.9±16.3)分],差异有统计学意义(P均<0.05)。7例患者的总体生存时间为10个月(95%CI:5~13个月),在中位随访期9.7(6~15)个月内,4例患者分别在治疗后6.5、7.7、9.4和12.5个月死亡,余3例在随访期间仍然存活。术后未出现消融相关的主要并发症,术后3 d内出现与胃肠相关的不良反应包括恶心、腹痛及食欲不振,对症治疗后均好转。

结论:

激光消融治疗进展期胰腺癌可行性强,安全性高且近期疗效肯定,值得临床进一步推广。

Objective:

To investigate the feasibility, safety and short-term efficacy of ultrasound-guided percutaneous laser ablation for advanced pancreatic cancer.

Methods:

A prospective study was performed. Seven patients with advanced pancreatic cancer, who were admitted to our hospital from September 2016 to October 2017, were treated with ultrasound-guided percutaneous laser ablation. Laboratory indicators (CA-199, serum lipase, amylase and blood glucose) before and after ablation, pain, quality of life scores, postoperative ablation-related adverse events and major complications were observed.

Results:

All procedures were successfully completed by laser ablation with a technical success rate of 100%. There was no significant difference in CA-199, serum lipase, amylase and blood glucose levels before and after laser ablation (P>0.05) . The patient's physical function was improved after 1 month of surgery [ (50.0±0) points vs. (30.8±3.4) points], and the pain was relieved compared with preoperative[ (26.7±11.3) points vs. (61.9±16.3) points.], which had significant statistically difference (P<0.05) . The median overall survival time was 10 months (95%CI: 5-13 months) . During the median follow-up period of 9.7 (6 to 15) months, 4 patients were treated with 6.5, 7.7 and 9.4 months, respectively, and died in 12.5 months, the remaining 3 cases were still alive during the follow-up period. There were no major complications related to ablation after operation. Gastrointestinal-related adverse reactions including nausea, abdominal pain and loss of appetite within 3 d after surgery were improved after symptomatic treatment.

Conclusions:

Laser ablation is effective in the treatment of advanced pancreatic cancer, with high safety and short-term curative effect. It is worthy of further clinical promotion.

表1 7例患者的一般临床特征
表2 消融前后实验室检测指标的变化
表3 患者行激光消融术后生活质量评分的改变 (±s
图1 典型病例(男性,68岁,进展期胰腺癌)行激光消融术前术后的MRI图
图2 典型病例(女性,68岁,进展期胰腺癌伴有胆结石、糖尿病患者)行激光消融术前术后的表现
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