纳米刀消融术治疗不可切除肝门部胆管癌的安全性与疗效

Safety and efficacy of nanoknife ablation for unresectable hilar cholangiocarcinoma

目的评价纳米刀消融术治疗不可切除肝门部胆管癌的安全性及近期疗效。方法回顾2016年3月至2017年5月15例不可切除肝门部胆管癌患者资料，分析纳米刀消融术治疗的临床效果。结果全部患者手术均顺利完成，术中部分患者出现偶发心律失常。13例患者CA190术后第1、3天明显升高，后逐步下降；1例CA19-9无明显变化；1例手术前后CA19-9均在正常范围。全部患者术后肝功能均逐步好转，总胆红素、AST、ALT逐步下降。15例患者心肌酶术后第1天均升高，5天内降至正常。术后出现心房颤动1例，上消化道出血1例。术后2周胆管再通率66．6％，1个月胆管再通率86．6％，2个月93．3％。结论纳米刀消融术治疗不可切除肝门部胆管癌安全性高，近期疗效显著，术后并发症少。

Objective To evaluate the safety and curative effect of nanoknife ablation in the treat- ment of unresectable hilar cholangiocarcinoma. Methods 15 patients with unresectable hilar cholangiocar- cinoma received nanoknife ablation treatment from March 2016 to May 2017. The clinical variables of the pa- tients before and after operation were analyzed. Results The operations in all the patients carred out suc- cessfully. Cardiac arrhythmia occurred in some patients during the operation accidentally. The level of CA19- 9 increased significantly on postoperative day 1, 3 and then gradually decreased in 13 patients; one patient had no significant change of CA19-9, and the data for another patient was always in the normal range. The liver function of all patients gradually improved after operation, and the level of total bilimbin, AST and ALT showed a downward trend. The myocardial enzyme in all the patients increased on postoperative day 1, then returned to normal within the following 5 days. Postoperative complications included atrial fibrillation （1 case）, upper gastrointestinal bleeding （1 case）. The recanalization rates of the bile duct at 2 weeks, 1 month, and 2 months after surgery were 66.6%, 86.6%, and 93.3%, respectively. Conclusion Nano- knife ablation has superior safety, noteworthy efficacy and less complications in the treatment of the unresec- table hilar cholangiocarcinoma in the short term.