微波消融联合吉西他滨治疗晚期胰腺癌的临床研究

Clinical study on microwave ablation combined with concurrent chemotherapy in treatment of locally advanced pancreatic cancer

目的 探讨经皮穿刺微波消融术联合化疗对晚期胰腺癌的疗效和并发症.方法 回顾性分析2013年8月至2016年4月收治的31例局部晚期胰腺癌患者,根据采取的主要治疗方法分为两组：对照组15例应用吉西他滨单药化疗;联合组16例于微波消融术后1-2周给予和对照组相同的方案化疗.采用χ^2检验比较两组患者的疗效及不良反应.结果 联合组和对照组的有效率分别为25.0%（4/16）和13.3%（2/15）,两组差异无统计学意义（χ^2=1.034,P=0.247）;局部控制率分别为68.8%（11/16）和26.7%（4/15）,两组差异有统计学意义（χ^2=6.579,P=0.012）.联合组疼痛缓解率为87.5%（14/16）,对照组为26.7%（4/15）（χ^2=8.146,P=0.004）.联合组和对照组的3、6、9、12个月生存率分别为100.0%和100.0%（P=1.000）、68.8%和40.0%（P=0.097）、56.3%和20.0%（P=0.033）、50.0%和13.3%（P=0.021）.联合组9例（56.3%）发生消融后综合征,7例（43.8%）术后1d出现血淀粉酶一过性升高,1例（6.3%）出现胰瘘,未发生术中和围术期死亡.两组的主要并发症为骨髓抑制、胃肠道反应等.结论 微波消融联合化疗治疗进展期胰腺癌具有协同作用,在疾病控制率、疼痛缓解率和延长患者生存期方面优于单纯化疗,而不良反应与单纯化疗相似.

Objective To investigate the clinical efficacy and safety of microwave ablation combined with concurrent chemotherapy in treatment of locally advanced pancreatic cancer. Methods Thirty-one patients with locally advanced pancreatic cancer with between August 2013 and April 2016 were divided into two groups according to the different treatments： 15 patients in the control group were treated with gemcitabine monotherapy; 16 patients in the combination group were treated with the same regimen as control group 1-2 weeks after the microwave ablation. The efficacy and side effects of the two groups were compared by chi-square test. Results The effective rates in the combination group and control group were 25.0%（4/16） and 13.3%（2/15）, the difference between the two groups was not significant （χ^2=1.034, P=0.247）; the local control rates were 68.8%（11/16） and 26.7%（4/15）, the difference between the two groups was statistically significant （χ^2=6.579, P=0.012）. The pain relief rates in the combination group and control group were 87.5%（14/16） and 26.7%（4/15） （χ^2=8.146, P=0.004）. The 3-, 6-, 9- and 12-month survival rates in the combination group and control group were 100.0%vs. 100.0%（P=1.000）, 68.8%vs. 40.0%（P=0.097）,56.3%vs.20.0%（P=0.033）,50.0%vs.13.3%（P=0.021）.In the combination group,9 cases （56.3%）occurred postablation syndrome,the serum amylase of 7 cases（43.8%）increased 1d after ablation,1 case （6.3%） occurred pancreatic fistula. The intraoperative and perioperative death did not occur. The main complications of the two groups were myelosuppression, gastrointestinal reactions and so on. Conclusions Microwave ablation combined with concurrent chemotherapy has a synergistic effect in treatment of locally advanced pancreatic cancer. In disease control rate, pain relief rate and survival of patients, microwave ablation combined with concurrent chemotherapy is better than chemotherapy alone, but the adverse reactions are similar.