不可逆电穿孔联合外科手术治疗特殊部位肝内胆管癌1例并文献复习

Irreversible electroporation combined with surgical operation in the treatment of intrahepatic cholangiocarcinoma at a special site:one case report and literature review

目的 探讨不可逆电穿孔(irreversible electroporation, IRE)治疗无法切除的肝恶性肿瘤的疗效。方法 我科2021年2月收治1例肝内胆管细胞癌患者,肿瘤大小2.2 cm×3 cm,已在外院行减黄术。肿瘤紧邻左右门静脉汇合部,术前增强CT及MR检查均显示肝内胆管细胞癌合并淋巴结转移。组织消化道肿瘤多学科协作团队(multidisciplinary team, MDT)讨论,经影像科、肝胆外科、放疗科、肿瘤内科等多名专家会诊,行开腹超声引导下肝S4段肿物穿刺术+肿物不可逆电穿孔消融术+肝门淋巴结清扫术。结果 活检肝组织内见中低分化腺癌浸润,结合免疫表型及形态,符合胆管细胞癌,大导管型。根据美国国立综合癌症网络(National Comprehensive Cancer Network, NCCN)指南胆道系统术后之辅助治疗方案,术后拟口服卡培他滨6月。术后8周,患者开始口服卡培他滨2 g/次,每日2次,2021年11月停服卡培他滨,因肿瘤复发行mFOLFOX6方案化疗3个周期。IRE术后共存活25个月。结论 不可逆电穿孔联合外科手术清扫淋巴结是治疗不可切除肝内胆管癌的合理选择,并可被推荐为最佳手段之一。

Objective To explore the efficacy of irreversible electroporation(IRE)in the treatment of unresectable liver tumor.Methods In February 2021,one patient with intrahepatic cholangiocarcinoma was admitted to our department.The tumor was adjacent to the confluence of the left and right portal veins,and pre-operative enhanced CT and MR examinations supported the diagnosis of intrahepatic cholangiocarcinoma with lymph node metastasis.The discussion of the multidisciplinary team(MDT)of digestive tract tumors,multiple experts from imaging,hepatobiliary surgery,radiotherapy,and oncology departments jointly developed an irreversible electroporation combined with regional lymph node dissection treatment plan.Results Biop-sy of liver tissue revealed infiltration of low-grade cholangiocarcinoma.According to the National Compre-hensive Cancer Network(NCCN)guidelines for adjuvant therapy after biliary system surgery,she was planned to take Capecitabine orally for 6 months after surgery.Starting from 8 weeks after surgery,the pa-tient received Capecitabine 2g/time,twice a day.And she stopped Capecitabine in November 2021 and received 3 cycles of mFOLFOX6 chemotherapy due to tumor recurrence.After IRE surgery,the patient survived for a total of 25 months.Conclusion Irreversible electroporation combined with surgical lymph node dissection is a reasonable choice for the treatment of unresectable intrahepatic cholangiocarcinoma,and is recommended as one of the best methods.