高强度聚焦超声联合吉西他滨治疗不可手术切除的胰腺癌临床效果观察

Clinical effects of high intensity focused ultrasound therapy in combination with gemcitabine for unresectable pancreatic carcinoma

目的探讨高强度聚焦超声（HIFU）消融热疗联合吉西他滨静脉滴注化疗治疗不可手术切除的胰腺癌的有效性及安全性。方法41例不可手术切除的胰腺癌患者随机分为两组，实验组21例和对照组20例。实验组采用HIFU联合吉西他滨静脉滴注化疗治疗；对照组单纯接受HIFU治疗。比较两组的临床治疗效果、临床受益率、肿瘤标记物CA19-9的变化及治疗过程中的不良反应。采用Kaplan—Meier法进行生存分析（中位生存时间，6个月生存率及12个月生存率），Log—rank法检验生存率。结果实验组中位生存时间为10．22个月，6个月及12个月的生存率分别为76．2％（16／21）和42．9％（9／21）；对照组中位生存时间为7．43个月，6个月及12个月的生存率分别为50．0％（10／20）和15．0％（3／20），实验组12个月生存率优于对照组，差异有统计学意义（χ^2=4．00，P〈0．05）。实验组临床受益率76．2％（16／21）优于对照组的45．0％（9／20），差异有统计学意义（χ^2=4．20，P〈0．05）；实验组疼痛缓解率66．7％（14／21）较对照组的45．0％（9／20）为高，但差异无统计学意义（P〉0．05）。治疗后2、3、4、5、6个月实验组血清肿瘤标志物CA19-9与对照组比较差异有统计学意义（t值分别为2．225、2．133、1．743、2．599、2．278，P均〈0．05）。结论HIFU联合吉西他滨静脉滴注化疗较单纯应用HIFU治疗疗效为优，具有更好的临床疗效。

Objective To investigate the therapeutic effect and safety of high intensity focused ultrasound（HIFU） combined with Gemcitabine in treating unresectahle pancreatic carcinoma. Methods Forty one patients suffering from unresectable pancreatic carcinoma were randomly divided into two groups. The patients in experimental group（ n = 21 ）were provided with HIFU in combination with gemcitabine therapy and those in control group（ n = 20）received HIFU treatment alone. The effect, clinical benefit rates, changes of tumor marker carbohydrate antigen 19-9 （CA19-9）and adverse reactions were compared between these two groups. The median survival time,6-month and 12-month survival rates were calculated by Kaplan-Meier method and Log- rank test. Results The median survival time,6-month and 12-month survival rates were 10.22 months,76. 2% （ 16/21 ） and 42. 9% （9/21） in experimental group, and they were 7.43 months, 50. 0% （10/20） and 15.0% （3/20） respectively in control group. Among them, 12-month survival rates was significantly higher in experimental group than that in control group （ χ^2 = 4. 00, P 〈 0. 05 ）. The clinical benefit rates in experimental group were significantly higher than that in control group [ 76. 2% （ 16/21 ） vs 45.0% （ 9/20 ）, χ^2 = 4. 20, P 〈 0. 05]. But there was no significant difference on pain remission rate between the two groups （66. 6% vs 45.0% ,P 〉 0.05 ）. There was significant difference on CA19-9 after treated for 2,3,4,5 and 6 months in experimental group than that in control group （ t = 2. 225,2. 133,1. 743,2. 599,2. 278, respectively, P 〈 0.05 ） . Conclusion HIFU in combination with Gemcitabine therapy is better than application of HIFU treatment alone. The former may become of the most effective treatmentfor unresectable pancreatic carcinoma