Clinical Application Of Nanoknife Ablation In Patients With Unresectable Hilar Cholangiocarcinoma

ObjectivesThis study was designed to evaluate the safety and clinical efficacy of nanoknife ablation in the treatment of unresectable hilar cholangiocarcinoma.The perioperative complications and recurrence and metastasis of the disease within 6 months after operation were evaluated.MethodsAnalyzing prospectively the clinical data of 23 patients with unresectable hilar cholangiocarcinoma who underwent nanoknife ablation in the Department of Hepatobiliary and Pancreatic Surgery of the Fifth Affiliated Hospital of Zhengzhou University from March 2016 to May 2018,and followed up for 6 months.The changes of myocardial enzymes were compared and analyzed between 1 day,5 day,2 week after surgery and 1 day before surgery;The changes of serum total bilirubin,aminotransferase and tumor marker were compared and analyzed at 1 day before surgery,1 day,3 days,1 week,2 weeks,1 month,2 months and 3 months.Biliary duct recanalization time was observed by Percutaneous transhepatic cholangial drainage(PTCD)or T-tube cholangiography 2 weeks,1 month and 2 months after operation.Quality of life(QOL)score and Karnofsky(KPS)score were used to evaluated the quality of life of patients 1 day before operation,1 month,2 months,3 months and 6 months after operation,and to compare the improvement of quality of life before and after operation.The incidence of perioperative complications was observed,and the recurrence and metastasis of the patients were observed monthly by contrast-enhanced CT or ultrasonography.Results 1 Safety evaluationThe operation was successfully completed in all 23 patients.The myocardial enzymes of all patients were normal before operation,increased on the first day after operation and decreased to normal within 5 days.The amount of bleeding during the nanoknife ablation was less.4 cases occurred arrhythmias and 1 case occurred elevated blood pressure during operation.Postoperative complications were reported in 5 cases,which included 1 case of atrial fibrillation,1 case of gastrointestinal bleeding,1 case of lymphatic leakage,1 case of Biliary tract infection and 1 case of hepatic abscess.2 Efficacy evaluation2.1 Liver function changes before and after the operation:The level of the AST and ALT in all patients increased significantly one day after operation,and began to decrease gradually three days after operation,and remained stable two weeks after operation.The level of the AST and ALT at one day,three days,two months and three months after operation were significantly different from those before operation(p< 0.05).There was no significant difference in the level of the AST and ALT at each time point after two weeks after operation(p>0.05).The liver function of 22 patients gradually improved and the level of the total bilirubin gradually decreased after the operation,of which 15 patients began to decrease one week after operation,4 patients began to decrease three days after operation,and 3 patients began to decrease significantly two weeks after operation,1 patient did not decline Postoperative.The total bilirubin of all patients was basically stable in three months after operation.There were significant differences in the levels of the total bilirubin between 2 weeks,1 month,2 months,3 months after operation and preoperative(p<0.05).2.2 Tumor markers changes before and after the operation:The CA19-9 in 2 patients were at normal level before and after operation;The remaining 21 cases were elevated before operation,of which 2 patients had no significant changes;The CA19-9 in 19 patients showed a downward trend within 3 months after operation,of which 13 patients showed an upward firstly and then downward trend after operation,of which 6 patients decreased gradually;The distinction beared significance when contrasted between 1 month,2 months and 3 month after operation and preoperative(p<0.05),the CA19-9 in 6 patients were increased after 6 month after the operation.2.3 The quality of life improvement of patients after the operation:The quality of life improved significantly Postoperative,There were significant differences in QOL score and KPS score at different time points in three month after the operation and Preoperative(p<0.05).2.4 Biliary recanalization after the operation: The bile duct recanalization rate was 65.2%(15/23)in 2 weeks,86.9%(20/23)in 1 month and 95.7%(22/23)in 2 months.2.5 The survival situations in the follow-up phase: During the follow-up period,1 case died of multiple organ failure,Intrahepatic metastasis occurred in 2 cases and local recurrence occurred in 2 cases.Conclusions1.The amount of bleeding during the nanoknife ablation of unresectable hilar cholangiocarcinoma is less;No cholangiojejunostomy,no bile leakage,fewer complications during perioperative period,and high security.2.Biliary tract can recanalize after the nanoknife ablation for patients with unresectable hilar cholangiocarcinoma.The quality of life is improved obviously,with marked clinical effect.This technology may be used as a new treatment option for patients with unresectable hilar cholangiocarcinoma.