The Clinical Study Of The Radio Frequency Ablation In Treating The Advanced Carcinoma Of Pancreas.

Objective: During the past few years, the radio-frequency ablation has been accepted by more and more medical professionals and patients for the advantages of minimal invasiveness, safety, reliable effectiveness, which play significant role in treating the liver cancer. A great number of scholars also apply it to treating lung cancer, kidney cancer, the results look favorable. The pancreas carcinoma are the alimentary malignancies which is devastating dangerous, of low cure rate and extremely poor prognostic. Recent years, the incidence of pancreatic tumor continues to increase, and in US has become the No. 2 gastrointestinal cancer cause of death. The statistics which count by the Office of Cancer Prevention and Treatment of China shows that from 1988 to 1997 the pancreatic carcinoma morbidity was close to the Euro-American countries in our country.The unnoticed onset, the rapid progression, the poor prognostic and the high mortality and the poor quality of life are the characteristics of pancreatic cancer. Worldwide integrated data shows pancreatic cancer 5-year survival rate is only 5% or lower--is the worst prognosis tumor. While Surgical resection remains the main therapy, but most patients are diagnosed at advanced stage, with no chance of operation for its early diagnosis is difficult. Therefore, palliative surgeries play an important role in the treatment of advanced pancreatic cancer. Whether applying the radio-frequency therapy on adanced pancreatic cancer patients who have no surgical resection opportunity has become an area of considerable interest in recent years doctors generally concern. In this study, we examined the safety and feasibility of radio-frequency ablation through clinical research., offer a new therapy for advanced pancreatic cancer.Methods: From March 2009 to March 2011, 32 patients with advanced pancreatic cancer which I've participated in at the Second Hospital Affiliated to Hebei Medical University and were treated with radiofrequency ablation, patients with advanced pancreatic cancer have been confirmed by CT or MRI combined with CA199, patients were cannot undergo radical resection or with hepatic metastasis according to the intraoperative exploration, postoperative were confirmed pancreatic cancer by pathologic diagnosis.Collect and analyze the clinical data: male 22 cases(68.75%), female 10 cases(31.25%); average age 63; 24 cases with abdominal pain(75%), 4 cases with jaundice(12.5%), 4 cases of abdominal pain with jaundice(12.5%); 24 cases of carcinoma of head of pancreas(75%), 8 cases of cancer of pancreatic body and tail(25%);the dimension of the tumors ranged from 3.4cm×3.6cm to 5.0cm×6.0cm, the mean dimension was 4.3 cm×4.5cm; 8 cases with liver metastasis(25%); 16 cases of diabetes before surgery(50%); 32 patients were underwent intraoperative radiofrequency ablation; intraoperative radiofrequency ablation of liver metastases simultaneously of 8 patients with liver; 22 patients of 24 cases of carcinoma of head of pancreas add the line gastrojejunostomy plus cholangioenterostomy immediately after radiofrequency ablation, 1 case of biliary tract exploration an T-tube drainage after radiofrequency ablation, 1 case underwent gallbladder jejunostomy after radiofrequency ablation.1 case of carcinoma of neck-body of pancreas add the resection of neck-body of pancreas and pancreatic tail jejunum anastomosis after radiofrequency ablation.The postoperative prescription for all cases includes the prohibition of food and drink , gastroenteral decompression, adequate intravenous nutrition and prophylactic antibiotics etc, the patients are given food when the level of urine amylase, serum amylase and the abdominal cavity drainage fluid amylase recovered, the volume of drainage fluid diminished, then the drainage tube were withdrawn. By observing the post-operative change of the level of blood glucose, serum amylase, celiac drainage liquid amylase value and lead flow, abdominal pain to improve conditions, postoperative CT change, CA199 change situation, postoperative survival time, to examine the feasibility and safety of radio-frequency ablation. Results:1 Change of the level of blood glucose of Postoperative patients: for the 32 patients who underwent radio- frequency ablation therapy, there are 16 patients who having diabetes mellitus before surgery. By comparing the fasting blood glucose of preoperative and postoperative values in patients (when diabetic patients supplied intravenous of high nutritional, the glucose-insulin ratio was 3:1, non-diabetic patients is 6:1), The slightly elevated post-operative blood glucose was observed in all patients, then declined gradually, considering as the stress response.The post-operation fasting blood glucose in 16 cases of patients without diabetes mellitus all could drop to preoperative level after 7 days; The slightly elevated post-operative blood glucose was observed after 7 days in the patients with diabetes mellitus, which could be fairly controlled by hypodermal injection of insulin. And the dosage of postoperative insulin was not significantly increased. Clinical data analysis is as follow(s?x±s):the Preoperative fasting blood glucose(6.6±1.7),the postoperative fasting blood glucose of 1 to 7 days(11.99±3.8),(11.2±2.9),(10.1±3.5),(9.9±3.2),(9.3±3.4),(8.1±2.7),(6.7±1.3). The radio-frequency ablation didn't cause the occurrence of diabetes after surgery.2 Observation of patients after radiofrequency ablation of serum amylase, abdominal drainage fluid amylase values and the volume of drainage: Clinical data analysis is as follows(x±s): Preoperative fasting blood amylase(113.25±176.81), Postoperative 1, 3, 5, 7 days blood amylase value respectively ( 119.00±108.57 ),( 44.25±11.41 ),( 38.625±12.68 ),(25.625±21.51);Postoperative 1, 3, 5, 7 days celiac drainage liquid amylase value respectively (1911.875±3951),(321±306.43),(146.625±167.42),(129.5±224.19). 8 cases(25%) of temporarily increase in serum amylase values, 23 cases of temporarily increase in abdominal drainage fluid amylase values, abdominal drainage fluid up to 450ml of the first postoperative day. None of the patients was given somatostatin, the target value reduced to normal soon, the volume of drainage decreased rapidly ,the longest intubation time was 30 days,the lest intubation time was 7 days, the average intubation time was 11.3 days. the median intubation time was 9 days. No acute pancreatitis occurred in patients.3 Relief of postoperative pain: 28 (87.5%)patients presented with various degrees of abdominal pain and or back pain. The patients were evaluated by numeric rating scale, 4 patients(14.29%) of mild, 12 cases(42.86%) of moderate and 12 cases(42.86%) of severe.After the therapy ,except for 3 patients, the pains of the others were relieved to various degrees, the total remission rate 89.3%. The 13 patients who administered painkiller before the therapy. After the therapy ,10 patients quitted painkiller and 1 patients decreased the dosage. Clinical data analysis is as follows ( ?x±s ) : preoperative(5.5±1.81),postoperative(1.63±0.86).4 Changes in patients with postoperative imaging examinations : The region of radiofrequency ablation showed post-necrotic inflammation which reviewed by CT pancreatic tumor showed necrosis after regional inflammatory changes, enhanced MRI tumor enhancement was significantly reduced compared with the preoperative.5 Changes in tumor marker CA199: CA199 of this group had increase before surgery, postoperative reviewing showed different degrees of decline, 8 cases reduced to normal rang(<37 u/L). Clinical data analysis is as follows(?x±s ) : preoperative CA199 ( 721.4±315.3 ) . postoperative CA199(184.2±290.77).6 Postoperative complications: In addition to these 8 patients had temporarily increase of serum amylase value,23 cases of temporarily increase in abdominal drainage fluid amylase values,1 case(3.125%) of pancreatic fistula, who recovered after 1 month,who was a carcinoma of neck-body of pancreas added the resection of neck-body of pancreas and pancreatic tail jejunum anastomosis after radiofrequency ablation;1 case (3.125%) of bile leakage (Fig.3) who was a carcinoma of head of pancreas without cholangioenterostomy and underwent intraoperative bile duct exploration and T tube drainage. 1 case (3.125%) of postoperative gastrointestinal bleeding who was pancreatic uncinate carcinoma with intraoperative cholecystojejunostomy and without gastrojejunostomy.7 Postoperative survival situation of patients: 1 case(3.125%) died after 15 days of post-operative gastrointestinal bleeding,1 case(3.125%) died one and a half month after the operation of severe intra-abdominal infections,2 cases(6.25%) died of multiple organ failure respectively on postoperative 2 months, 3 months due to Systemic widely metastasis. The remaining 28 cases survived more than 6 months, 1 patient has survived up to 15 months.Conclusion: In this study, clinical observation of 32 patients who underwent radio-frequency ablation therapy for late-state pancreatic carcinoma showed that for the patients with late-stage pancreatic cancer, the radio-frequency ablation therapy is feasible and safe, as long as the area precisely located and avoiding the direct ablation of large vessels and pancreatic and bile ducts, simultaneously some of the necessary auxiliary measures such as cholecystojejunostomy and gastrojejunostomy, intensify the postoperative care for complications and make sure the drainage un-occluded ,there is few possibility of severe complications. The total of 32 patients after radiofrequency ablation showed that the CA199 was decreased, pain was Significant relieved, the lifetime has different degrees of extension, the recent therapeutic effects was acceptable,but the long-term outcome was generally poor.