冷循环射频消融治疗不可切除胰腺癌

Treatment of unresectable pancreatic carcinoma by radiofrequency ablation with ＇ cool-tip needle＇ ：report of 18 cases

目的探讨射频消融治疗胰腺癌的疗效和安全性。方法对18例射频消融治疗胰腺癌的患者的临床资料进行回顾性分析。结果本组11．1％（2／18）的胰体尾癌患者术后肿瘤标志物从数百降到正常，77．8％（14／18）的患者射频消融治疗后背部放射痛或腹痛减轻，其中6例疼痛完全消失。77．8％（14／18）的患者术后复查B超或CT后发现肿瘤有不同程度的缩小。全组死亡率为22．2％（4／18），其中3例表现为消化道出血，1例表现为急性肾功能衰竭。本组初期有16．7％（3／18）发生胰漏。随访有8例分别于术后1～8个月死亡。最长至今生存51个月。结论射频消融结合必要的内引流治疗中晚期胰腺具有减轻疼痛的疗效。应用当今的射频模式治疗胰头肿瘤是危险的，治疗胰体尾肿瘤是安全的。通过胃管往十二指肠灌注冰水和改变射频机器参数可减少胰头肿瘤射频的并发症。

Objective To explore the effects of treatment of unresectable pancreatic tumors by radiofrequency ablation （RFA） with ＂cool-tip needle＂. Methods 18 patients with unresectable pancreatic tumors, 8 with pancreatic head carcinoma and 10 with pancreatic body and tail carcinomas, 12 males and 6 females, aged 66.2, underwent RFA under laparotomy for 3 times and simultaneous infusion of iced normal saline. The clinical data were retrospectively analyzed. Results The level of CA19-9, a tumor marker, returned to normal after RF in 2 patients. Back pain was alleviated in 14 patients. B mode ultrasonography or CT examination showed decrease of tumor volume in 14 patients after RF. Pancreatic fistula occurred in 3 patients （ 16.7 % ） and then healed smoothly in 7 - 10 days with after routine abdominal drainage. The mortality was 22.2% （4/18）. In the 4 death cases, tumors were all located in the pancreatic head; three patients died suddenly of massive gastrointestinal hemorrhage at Days 4, 30, and 40 days postoperative respectivelyafter RF and the other patient died of acute renal failure at Day 2 postoperativedays after RF. 8 patients died 1 - 8 months after RF. After 51 months, 1 patient still survived. Conclusion RFA is effective in relieving the back pain for in unresectable pancreatic tumor patientsis efficiently relieving the back pain. Standard use of cool-tip RFA is dangerous for pancreatic head tumor carcinoma close to portal vein, but safe for those located in the body and tail of the pancreas. Making the Infusion of icedcooling-water flow via a gastric tube into the duodenum and changing change of the parameters of the RF system can reduce the associated complications.