氩氦刀冷冻消融结合I^(125)粒子植入治疗肝门区胆管癌5例报告

Efficacy of argon-helium cryoablation combined with I^(125) particle implantation in treatment of hilar cholangiocarcinoma: a report of 5 cases

目的探讨氩氦刀冷冻消融结合I125粒子植入治疗肝门区胆管癌的疗效。方法选取本院2010年1月至2013年6月收治的5例肝门区胆管癌患者,在CT定位下先由穿刺针确定肿瘤位置及穿刺角度,后以17 mm氩氦刀刺入肿瘤组织,在最靠近冰球主胆管及左右肝管汇合处靠近氩氦刀侧置入测温针,氩氦刀与胆管壁的最近距离大于3 cm,对于包绕主干胆管的肿瘤组织,距胆管壁约0.8cm沿纵轴间距0.3~0.5 cm布置I125粒子,然后进行2个周期冷冻消融。结果本组5例患者,术后1周内疼痛症状完全缓解2例,明显缓解3例;1周内总胆红素明显下降2例,轻度升高1例。无出血、气胸等并发症。结论氩氦刀冷冻消融结合I125粒子植入对于肝门区胆管癌患者在近期内能有效缓解症状,改善生活质量,但对远期疗效的评价尚须大样本病例研究及长期随访。

Objective To investigate the efficacy of argon - helium cryoablation combined with I^125 particle implantation in the treatment of hilar cholangiocarcinoma. Methods Five patients with hilar cholangiocarcinoma who were admitted to our hospital from January 2010 to June 2013 were selected. Under CT localization, the tumor location and puncture angle were determined using a puncture needle, and then the tumor was pierced with a 17 mm argon - helium knife ; a temperature - sensing needle was placed at the main bile duct and confluence of the left and right hepatic ducts closest to the ice ball and near the side of argon - helium knife ; the minimum distance between the argon - helium knife and bile duct wall was greater than 3 cm; for the tumor tissue surrounding the main bile duct, I^125 particles were placed along the longitudinal axis about 0.8 cm from the bile duct wall at a spacing of 0.3 - 0.5 cm, and then two cycles of cryoablation were performed. Results Of the five patients, two had complete relief of pain symptoms within one week after operation, and three had significant relief; two cases showed a significant decrease in total bilirubin within one week, and one showed a mild increase. No complications such as bleeding and pneumothorax were seen. Conclusion Argon - helium cryoablation combined with I^125 particle implantation can effectively relieve symptoms and improve the quality of life in patients with hilar cholangiocarcinoma within a short period after operation, but the evaluation of its long - term efficacy still needs large - sample case studies and long - term follow - up.