胰十二指肠肿瘤隔离冷冻治疗的可行性研究

EXPERIMENTAL STUDY OF CRYOSURGERY FOR ISOLATED PANCREANO DUODINAL AREA: A POSSIBLE THERAPY FOR PANCREANO DUODINAL NEOPLASM

冷冻对恶性肿瘤有确切治疗效果，但常规胰十二指肠区域冷冻后常发生邻近的消化道损伤等严重并发症，从而限制了冷冻治疗在该区域肿瘤治疗中的临床应用。为此，作者设计了在重建消化道的基础上，胰腺十二指肠肿瘤隔离冷冻的方法，并通过动物实验验证其可行性。实验采用健康家猪４只，开腹后分别作胆总管、胰体尾、胃肠、肠肠离断，除后方的门静脉和肠系膜血管外，将胰十二指肠区和其它腹内器官隔离，用ＬＣＳ２０００外科冷冻治疗机，以－１７０℃低温，持续１０分钟的技术条件，将此区重复冷冻２次，而后作胃肠和胆肠吻合。结果：术后动物全部存活，胰淀粉酶在短暂增高后迅速恢复正常，肝功能和血糖无明显变化。除１例发生较小的胰腺假性囊肿外，无任何胆、胰、肠的并发症。作者强调一定深度和作用时间的超低温是破坏胰腺组织和预防冷冻后胰腺炎的主要措施。文中还对相关的技术因素进行了讨论。

In order to avoid lesion of adjacent organs which were often occurred after routine cryotherapy of pancreano duodinal area, a new cryosurgical method of isolated pancreano duodinal area was designed for treatment of neoplasm in this area, the feasibility of this method was tried in four pigs.After bile common duct, tail of pancreas, stomach, and jejunum were divided and protected by dry cotton pad, the isolated pancreano duodinal area was twice fozen to -170℃, maintaining ten minutes with LCS 2000 cryogenic surgical system, then alimentary tract was reconstructed with cholecystojejunostomy and gastroenterostomy. Animals were observed for 1-4 weeks. There was only transient elevation of amylase postoperation and the liver function and blood sugar remained normal. No any complication was seen except a small pseudocyst in lesser omentum. Thorough destruction of pancreatic tissue by enough deep and time course of cryotherapy was emphasized and some technic problem also were discussed. Based on our experiment, cryosurgery of isolated pancreano duodenum will be considered as a safe and effect therapy of pancreano duodinal neoplasm.