电穿孔现象与不可逆电穿孔治疗晚期进展期胰腺癌的研究进展

Electroporation phenomena and progress on treatment of advanced progressive pancreatic cancer with irreversible electroporation

跨膜电压超过临界值时,细胞膜会发生电穿孔现象,物理学表现为细胞膜振荡或纳米级微孔形成,生物物理学表现为可逆电穿孔和(或)不可逆电穿孔,前者主要用于细胞内外DNA、基因或粒子递送,后者近年来开始用于细胞消融。动物实验表明,不可逆电穿孔细胞消融效果确切,无散热效应,并可保存血管、胆管、胰管、肾盂集合系统等细胞外基质完好,受损的神经功能可恢复,肾盂黏膜上皮可再生。对晚期进展期胰腺癌患者,该治疗方法可明显延长无进展生存期、远期无进展生存期和总生存期,无严重并发症。超声引导下即可完成不可逆电穿孔(IRE)消融治疗过程,影像学是评估治疗效果的方法之一。

Electroporation or electrical breakdown phenomenon is observed in the plasma membranes where the membrane potential exceeds the critical value, which mechanically induces membrane oscillation, or temporary or permanent nanoscale pore formation that is biophysically called reversible electroporation or irreversible electroporation. Usually, the former is intensively used to transport DNA, genes or particles into cells for decades. However, the latter is initiated to ablate tumor cells recently, and the well-definite ablation is revealed in vitro and in vivo. Irreversible electroporation could preserve the extracellular matrix of blood vessels bile duct, pancreatic duct and renal pelvis system, and has no heat-sink effects. Furthermore, the injured nerves could recover, and the epithelium cells could regenerate in renal pelvis system. For the patients with advanced pancreatic cancer, the progression-free survival, long-term progression-free survival and overall survival are obviously prolonged after this treatment. This procedure could be flexibly performed under the guidance of ultrasound, and the imaging modality is a promising method to evaluate the ablation effects of irreversible electroporation.