经皮冷消融治疗局部进展性胰腺癌的可行性

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.

Feasibility and safety of percutaneous cryoablation for locally advanced pancreatic cancer

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.