内镜超声引导下射频消融治疗三例晚期胰腺癌的临床分析

Endoscopic ultrasound guided radiofrequency ablation for the treatment of advanced pancreatic cancer

目的初步探讨内镜超声引导下射频消融（EUS-RFA）的可行性、安全性和短期疗效。方法对3例晚期、无手术指征的胰腺癌患者进行EUS-RFA治疗。在EUS引导下以22G穿刺针穿刺入胰腺癌病灶，1Fr的射频消融针通过穿刺针腔进入病灶，采用单极模式，以功率10w消融2min，之后再以15w消融2min。与前一针道相隔约1～1．5cm选择另一针道，再次进针，重复消融。结果3例患者的平均年龄为63岁。2例为胰尾癌，1例为胰体癌，肿瘤平均直径为3．6cm。术前行EUS引导下细针穿刺活检均见到癌细胞。1例患者间隔2周分别行3次EUS-RFA，2例患者行1次EUS-RFA，平均每个病灶行EUS．RFA3．67次。术后2周复查EUS，3例病灶直径平均缩dq3．9％，病灶内均出现大小不等的空泡变性。术后血清CA19-9浓度平均下降46．5％，腹痛未见明显加重。治疗后48h内均未出现出血、胰腺炎、穿孔等短期并发症。平均随访49d，未见其他并发症。结论EUS-RFA可使胰腺癌病灶直径缩小，可降低血清CA19-9浓度，方便可行，安全性良好。

Objective To investigate the feasibility, safety, and short term efficacy of endoscopic ultrasound guided radiofrequency ablation （EUS-RFA）. Methods Three patients with advanced, inoperable pancreatic carcinoma underwent EUS-RFA. Under the guidance of EUS, a 22 gauge fine needle was punctured into the pancreatic carcinoma, and 1 Fr radiofrequency （RF） catheter was placed into the cancer through this 22 gauge needle. RFA was applied at 10 watts for 2 minutes, and then 15 watts for another 2 minutes. The second needleg tract was selected and punctured about 1 - 1.5 cm apart from the first needle tract, and the ablation was repeated. Results The average age of these 3 patients was 63 years old. Two patients were diagnosed to have pancreatic tail cancer and one was pancreatic body cancer, and the mean diameter of the tumor was 5.6 cm. Pre-operative EUS-FNA confirmed the presence of malignant ceils. EUS-RFA was performed three times at an interval of 2 weeks in the first patient and one time in the last two patients. The average session of EUS-RFA of each lesion was 3.67 times. After 2 weeks, EUS showed that the diameter of the lesions was reduced by 13.9% on average. There were vacuolar degenerations of variable sizes in those lesions. The serum level of CA19-9 was averagely decreased by 46.5%. Abdominal pain was not obviously aggravated. There were no episodes of pancreatitis, perforation or bleeding within 48 hours after the procedure. The mean follow-up time was 49 days, and no complications occurred. Conclusions EUS-RFA can reduce the diameter of pancreatic carcinoma and decrease the serum level of CA19-9, and it is feasible and safe.