手术联合氩氦靶向冷冻消融在中晚期胰头癌中的应用(附15例报告)
The Application of Surgical Treatment in Combination with Targeted Cryoablation on Advanced Carcinoma of Head of Pancreas:A Report of 15 Cases
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摘要: 目的:探讨已丧失手术机会的中晚期胰头癌,开腹直视下行氩氦靶向冷冻消融术联合介入灌注治疗的近期临床疗效及相关并发症。方法:剖腹直视B超引导下,对不能手术根治性切除的中晚期胰头癌,用2~3把2mm冷冻器插入胰头肿瘤内进行同步冷冻消融,同时行胆肠内引流减黄及胃肠转流手术,术后常规联合动脉介入区域性化疗2~4次。结果:15例中肿瘤冷冻消融范围>70%以上者12例,冷冻范围在50%左右者3例。随访:4例失访,术后生存最短7个月,最长18个月,中位生存期13.4个月,总体生存率63.6%(7/11)。术后7±2天胆红素恢复正常;胆瘘1例;无胰瘘。术后4周CA19-9、CA125、CA242、CA50等肿瘤标志物检测较术前均有明显下降(P<0.05)。结论:丧失手术机会的中晚期胰头癌于术中行氩氦靶向冷冻消融治疗是安全、可行的、有效的。Abstract: Objective: To discuss the clinical effects and relative complications of Argon Heliumcryoablation during the operation combined with arterial infusion after the operation on advanced pan-creatic cancer.Methods: Argon Helium cryoablation was conducted under the direct sight and by BUltrasonic lead during the operation with 2- 3 Argon Helium probes placed directly to pancreatic tumor,while conducting drainage in gallbladder and intestines and transfer drainage between stomach and in-testines in advanced- stage pancreatic cancer patients who had no operation chance. Transcatheter arte-rial infusion was usually used for 2 to 4 times after the operation. Results: There were 12 cases withover 70% freezing area and 3 with about 50% freezing area. Follow- up: Life span varied from 7 to 18months, with the median of 13.4. The survival rate is 63.6% (7/11). Jaundice disappeared in 7± 2 daysafter operation. One case has biliary fistula, no pancreatic fistula occurred. There was obvious decreasefor tumor markers such as CA199, CA125, CA242 and CA504 weeks after the operation, compared withpre-operation (P<0.05).Conclusions: Argon Helium cryoablation during the operation on advanced-stage pancreatic cancer is safe, feasible and effective.