微波消融术与氩氦刀冷冻术治疗中晚期肝内胆管细胞癌的临床疗效比较-东南大学学报医学版

微波消融术与氩氦刀冷冻术治疗中晚期肝内胆管细胞癌的临床疗效比较

单位：1. 东南大学医学院, 江苏南京 210009;
2. 东南大学附属中大医院介入与血管外科, 江苏南京 210009;
3. 江苏省人民医院介入科, 江苏南京 210029;
4. 东部战区总医院医学影像科, 江苏南京 210002

分类号：R735.8

出版年·卷·期（页码）：2019·38·第四期（585-590）

摘要：

目的：对比微波消融术与氩氦刀冷冻术治疗中晚期肝内胆管细胞癌的有效性与安全性。方法：收集2010年1月至2017年1月在3家医院行微波消融术或氩氦刀冷冻术治疗的50例肝内胆管细胞癌患者的临床资料，其中微波组31例，氩氦刀组19例。比较两组技术成功率、短期疗效、生存期及并发症。结果：（1）微波组和氩氦刀组消融成功率分别为93.5%（29/31）和94.7%（18/19），差异无统计学意义（P>0.999）。（2）微波组和氩氦刀组术后1个月时，客观缓解率分别为93.1%和83.3%（P=0.357），完全缓解率与部分缓解率以及相应的血液学指标变化除丙氨酸转氨酶（P=0.006）外差异无统计学意义（P>0.05）。（3）中位生存时间微波组为12个月（95%CI：9.6~14.4），氩氦刀组为8个月（95%CI：5.9~10.1），差异无统计学意义（P=0.815）。（4）肝区疼痛、消化不良、血胆红素升高、感染的发生数氩氦刀组均明显多于微波组（P<0.05）。结论：微波消融术与氩氦刀冷冻消融术治疗中晚期肝内胆管细胞癌的临床疗效无明显差异，但微波消融术的术后并发症更少。

Objective: To compare the efficacy and safety of percutaneous microwave ablation(MVA) and cryoablation in the treatment of advanced intrahepatic cholangiocarcinoma(ICC).Methods: Fifty ICC patients of three hospitals were included in this retrospective study from 2010 to 2017. Thirty-one patients underwent MWA, and nineteen patients underwent cryoablation. Technical success rate, objective response rate, overall survival and complication rates were compared between the ablation groups. Results: (1) The technical success rates, 29(93.5%) of 31 MVA procedures versus 18(94.7%) of 19 cryoablation procedures, were not significantly different between the ablation groups (P>0.999). Operation times of cryoablation group were longer than those of MVA group (P<0.001).(2) One month after these treatments, objective response rates, 27 (93.1%) of 29 MVA procedures versus 15(83.3%) of 18 cryoablation procedures, were not significantly different between the two groups (P>0.999).(3) The medium survival times, 12(95%CI: 9.6-14.4) months of MVA group versus 8(95%CI: 5.9-10.1) months of cryoablation group, were not significantly different.(4) Hepatic pain, dyspepsia, serum bilirubin and infection in the argon-helium knife group were significantly higher than those in the microwave group (all P<0.05). Conclusion: There is no significant difference between microwave ablation and argon-helium cryoablation in the treatment of advanced intrahepatic cholangiocarcinoma, but the complications of microwave ablation are less than those of argon-helium cryoablation.

参考文献：

[1] RAZUMILAVA N,GORES G J.Cholangiocarcinoma[J].Lancet,2014,383(9935):2168-2179.
[2] KHAN S A,DAVIDSON B R,GOLDIN R D,et al.Guidelines for the diagnosis and treatment of cholangiocarcinoma:an update[J].Gut,2012,61(12):1657-1669.
[3] DODSON R M,WEISS M J,COSGROVE D,et al.Intrahepatic cholangiocarcinoma:management options and emerging therapies[J].J Am Coll Surg,2013,217(4):736-750.
[4] BLECHACZ B,GORES G J.Cholangiocarcinoma:advances in pathogenesis,diagnosis,and treatment[J].Hepatology,2008,48(1):308-321.
[5] KHAN S A,EMADOSSADATY S,LADEP N G,et al.Rising trends in cholangiocarcinoma:is the ICD classification system misleading us?[J].J Hepatol,2012,56(4):848-854.
[6] RIZVI S,GORES G J.Pathogenesis, diagnosis, and management of cholangiocarcinoma[J].Gastroenterology,2013,145(6):1215-1229.
[7] SPOLVERATO G,KIM Y,ALEXANDRESCU S,et al.Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative-intent surgical resection[J].Ann Surg Oncol,2016,23(1):235-243.
[8] PARK J,KIM M H,KIM K P,et al.Natural history and prognostic factors of advanced cholangiocarcinoma without surgery,chemotherapy,or radiotherapy:a large-scale observational study[J].Gut Liver,2009,3(4):298-305.
[9] LEE J,PARK S H,CHANG H M,et al.Gemcitabine and oxaliplatin with or without erlotinib in advanced biliary-tract cancer:a multicentre,open-label,randomised,phase 3 study[J].Lancet Oncology,2012,13(2):181-188.
[10] EISENHAUER E A,THERASSE P,BOGAERTS J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[11] U.S.Department of Health and Human Services.Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 November 27,2017 National Institutes of Health National[C/OL].https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/CTCAE_v5_Conversion_Amendment_Request.pdf
[12] AMINI N,EJAZ A,SPOLVERATO G,et al.Temporal trends in liver-directed therapy of patients with intrahepatic cholangiocarcinoma in the United States:a population-based analysis[J].J Surg Oncol,2014,110(2):163-170.
[13] 许健,曹建民,卢光明.氩氦刀靶向消融治疗实体肿瘤的评价[J].介入放射学杂志,2009,18(7):481-483.
[14] YU M A,LIANG P,YU X L,et al. Sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma[J].Eur J Radiol,2011,80(2):548-552.
[15] ZHANG S J,HU P,WANG N,et al.Thermal ablation versus repeated hepatic resection for recurrent intrahepatic cholangiocarcinoma[J].Ann Surg Oncol,2013,20(11):3596-3602.
[16] AMINI A,GAMBLIN T C.Palliation:treating patients with inoperable biliary tract and primary liver tumors[J].Surg Oncol Clin N Am,2014,23(2):383-397.
[17] 王延明,王能,许赟,等.微波消融治疗7403例肝癌的严重并发症[J].中华肝胆外科杂志,2016,22(10):655-660.
[18] 张德东,于晓玲,梁萍,等.经皮微波消融治疗肝内胆管细胞癌的疗效分析[J/OL].中华医学超声杂志(电子版),2011,8(11):2314-2319.
[19] CHIANG J,CRISTESCU M,LEE M H,et al.Effects of microwave ablation on arterial and venous vasculature after treatment of hepatocellular carcinoma[J].Radiology,2016,281(2):617.
[20] MORELAND A J,LUBNER M G,ZIEMLEWICZ T J,et al.Evaluation of a thermoprotective Gel for hydrodissection during percutaneous microwave ablation:in vivo results[J].Cardiovasc Intervent Radiol,2015,38(3):1-9.
[21] 陈敏山,陈敏华,叶胜龙,等.原发性肝癌局部消融治疗的专家共识[J].临床肿瘤学杂志,2011,16(1):70-73.
[22] 中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):705-720.
[23] 朱传东,王礼学,徐瀚峰,等.CT引导下经皮微波消融术治疗特殊部位小肝癌36例临床研究[J].现代医学,2017,36(11):1568-1572.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录