超声引导技术在术中冷冻消融治疗局部进展期胰腺癌中的应用

目的评估超声引导技术在局部进展期胰腺癌术中冷冻消融治疗中应用的可行性和安全性。方法回顾性分析我院胰腺中心接受超声引导的术中冷冻消融治疗局部进展期胰腺癌患者38例,收集一般临床资料、观察术中冷冻消融的超声表现以及记录不同布针方案中冷冻冰球大小,并观察术后并发症,评估超声引导技术在胰腺癌术中冷冻消融中的有效性和安全性。结果所有患者均安全完成手术,单针方案和双针方案冷冻消融时冰球最大直径分别为(3.17±0.57)cm和(4.50±1.39)cm。围手术期内无患者死亡,术后发生胰瘘(POPF)9例(23.7%),主要为A级生化漏7例,B级瘘仅2例;发生腹腔出血(PPH)1例(2.63%);发生胃排空障碍(DGE)7例(18.4%)。术后3个月复查CT按RECIST标准达到部分缓解(PR)的17例(44.74%),肿瘤稳定(SD)的20例(52.6%),肿瘤进展(PD)1例(2.63%),所有患者均观察到病灶部位均匀密度的坏死区域。结论超声引导的术中冷冻消融治疗局部进展期胰腺癌具有准确、适形、安全等特点,为临床不可手术切除的胰腺癌治疗提供了新的技术手段,值得推广。

Ultrasound-guided Technology Used in Intraoperative Cryoablation for Locally Advanced Pancreatic Cancer

Objective To evaluate the feasibility and safety of ultrasound-guided cryoablation for locally advanced pancreatic cancer.Methods From 38 patients with locally advanced pancreatic cancer were treated by ultrasoundguided intraoperative cryoablation in the Pancreas Center,the 2 nd Affiliated Hospital of Nanjing Medical University.We collected the general clinical data,observed ultrasonographic manifestations of intraoperative cryoablation,recorded the size of ice balls in different probe placement schemes,and observed the postoperative complications to evaluate the efficacy and safety of ultrasound-guided cryoablation in pancreatic cancer.Results All patients underwent the operation safely.The maximum diameter of ice balls in single-probe cryoablation and double-probe cryoablation were(3.17±0.57)cm and(4.50±1.39)cm,respectively.No patient died during the perioperative period.Postoperative pancreatic fistula(POPF)occurred in 9 cases(23.7%),including 7 cases of grade A and 2 cases of grade B.Postpancreatectomy hemorrhage(PPH)occurred in 1 case(2.63%)and delayed gastric emptying(DGE)in 7 cases(18.4%).At 3 months after operation,17 cases(44.74%)achieved partial response(PR),20 cases(52.6%)had stable diseases(SD),and 1 case(2.63%)had progressive diseases(PD),according to RECIST criteria.Necrotic regions with uniform density were observed in all cases.Conclusions Ultrasound-guided intraoperative cryoablation for locally advanced pancreatic cancer is accurate,conformal and safe,which provides a new method for the treatment of unresectable pancreatic cancer and is worthy of promotion.