内镜超声引导下聚桂醇消融治疗胰腺囊性肿瘤长期疗效的前瞻性研究(含视频)

Long-term effects of endoscopic ultrasonography-guided lauromacrogol ablation for the treatment of pancreatic cystic neoplasms: a prospective study (with video)

目的在大样本基础上进一步探讨内镜超声引导下聚桂醇消融术(endoscopic ultrasonography-guided lauromacrogol ablation,EUS-LA)治疗胰腺囊性肿瘤(pancreatic cystic neoplasms,PCNs)的安全性和长期疗效。方法前瞻性纳入2015年4月—2019年4月解放军总医院第一医学中心255例疑诊PCNs的患者,其中仅使用聚桂醇作为消融剂行EUS-LA治疗的患者共计57例。以消融术后影像学体积变化为疗效评估标准,并观察记录并发症发生情况。结果纳入的57例行EUS-LA治疗的PCNs患者年龄(52.0±14.6)岁,其中女38例、男19例。33例病变位于胰腺头颈部,24例位于胰腺体尾部。共有50例患者接受影像学随访,EUS-LA治疗后囊肿的中位体积从术前的11434.1 mm^3减小至639.4 mm^3(Z=-5.556,P<0.01),中位直径从32.0 mm减小至12.0 mm(Z=-6.161,P<0.01),完全缓解24例(48.0%),部分缓解14例(28.0%),稳定12例(24.0%)。12例患者进行第2次消融,总消融69例次,总体并发症发生率为4.3%(3/69)。随访12个月以上的患者34例,其中18例(52.9%)获得完全缓解,9例(26.5%)获得部分缓解,7例(20.6%)病变稳定。结论EUS-LA治疗PCNs安全有效,且长期疗效稳定。

Objective To determine the safety and long-term efficacy of endoscopic ultrasonography-guided lauromacrogol ablation(EUS-LA)for treatment of pancreatic cystic neoplasms(PCNs)with a larger population.Methods From April 2015 to April 2019,255 patients suspected of PCNs were enrolled in the First Medical Center of Chinese PLA General Hospital in the study,and 57 patients underwent EUS-LA.The effectiveness of EUS-LA was determined based on imaging volume changes.The occurrence of complications was observed and recorded.Results Among the 57 patients who underwent EUS-LA,38 were female and 19 were male,with the mean age of 52.0±14.6 years.The cysts were located in the head/uncinate of the pancreas in 33 patients and in the body/tail of the pancreas in 24 patients.A total of 50 patients were followed up by imaging examinations.After treated by EUS-LA,the cyst median volume sharply reduced from 11434.1 mm^3 to 639.4 mm^3(Z=-5.556,P<0.01),and the median diameter decreased from 32.0 mm to 12.0 mm(Z=-6.161,P<0.01).Postoperative imaging showed a complete resolution in 24 patients(48.0%),partial resolution in 14 patients(28.0%),and persistent cyst in 12 patients(24.0%).The total number of ablation was 69,and there were 12 patients undergoing a second ablation.The adverse events rate was 4.3%(3/69).Among the 34 patients followed up for 12 months or more,complete resolution was observed in 18 patients(52.9%),partial resolution in 9(26.5%),and persistent cyst in 7(20.6%).Conclusion EUS-LA is effective and safe for the treatment of PCNs.Its effectiveness is stable after more than 12 months′follow-up.