Nanoknife Ablation Combined With Biliary Composite Stent In The Treatment Of Unresectable Hilar Cholangiocarcinoma

ObjectivesTo analyze the clinical data of patients with unresectable hilar cholangiocarcinoma treated by nanoknife ablation combined with biliary composite stent,and to explore its technical advantages and clinical application value.MethodsTwenty patients with unresectable hilar cholangiocarcinoma who were treated with nanoknife ablation combined with biliary composite stent implantation from October 2017 to January 2019 in the Fifth Affiliated Hospital of Zhengzhou University were selected as the research subjects.The follow-up date was up to July 2019.Compare and analyze the improvement of patients' quality of life and changes in biochemical indicators before and after surgery;observe and record the postoperative complications;After operation,combined with clinical manifestations,biochemical indexes,the amount of drainage,and through nuclear magnetic resonance dynamic contrast-enhanced scan,MRCP and other imaging examination and PTCD angiography to understand the patency of bile duct.The survival of patients within 6 months after operation was recorded.Results1 Efficacy evaluation1.1 Changes in tumor marker CA19-9 before and after operation:Among the 20 patients,17 patients had a significant increase in tumor marker CA19-9 before operation,and the remaining 3 patients were in the normal range before and after operation.Among the pre-elevated patients,16 cases had a progressive decline after operation,and 1 case had no significant changes before and after the operation.After repeated inspections at different times after surgery,the overall trend was declining;2 weeks,1 month,2 months,and 3 months after surgery compared with the tumor marker CA19-9 the day before operation,the difference was statistically significant,p<0.05.1.2 Changes in liver function indexes before and after surgery:The total bilirubin of all patients was higher than normal on the 1st day before surgery,and slightly increased on the 1st day after the operation,followed by a progressive decline overall.There were significant differences between 2 weeks,1 month,2 months,3 months after operation and 1 day before operation(p<0.05);20 patients had higher AST and ALT than normal values on the 1st day before surgery,and all patients had a significant increase in ALT and AST on the 1st day after surgery,especially AST.After that,the two showed a progressive downward trend,and stabilized at 1 month after operation.Compared with 1 day before operation,the difference was statistically significant on the 1 st day,3rd day,1 week,2 weeks,and 1 month after operation,p<0.05.1.3 Quality of life improvement before and after surgery:The quality of life scores and Karnofsky scores of 20 patients showed that the quality of life was significantly lower than normal,and the quality of life was significantly improved at different time after operation.the quality of life score and Karnofsky score at 1 week,1 month,2 months and 3 months after operation were significantly higher than those at 1 day before operation(p<0.05).1.4 Removal of PTCD tube after surgery:All patients were able to remove the PTCD tube after operation.The median time from postoperative to PTCD tube removal was 49 days,and the median time from placing the PTCD tube to PTCD tube removal was 65 days.1.5 Survival during the follow-up period:3 cases of local recurrence,1 case of intrahepatic metastasis,and 1 case died of multiple organ failure during the follow-up period.2 Safety evaluation2.1 Hemodynamic changes before and after surgery:The operation was successfully completed in 20 patients.The heart rate and blood oxygen saturation of all patients were within the normal range during ablation.The blood pressure of 4 patients increased rapidly within 2 minutes after the start of ablation,and there was no arrhythmia before and after ablation.The myocardial enzymes of all patients were in the normal range on the first day before surgery,and the myocardial enzymes of all patients increased on the first day after surgery,and all myocardial enzymes of the patients fell to the normal range within five days;There was no obvious abnormality in ECG before and after operation.2.2 Complications during the follow-up period:Pulmonary infection occurred in 1 case,biliary tract infection in 2 cases,liver abscess in 1 case,and biliary composite stent obstruction in 5 cases.Conclusions1.For unresectable hilar cholangiocarcinoma,nano-knife ablation combined with bile duct composite stent implantation has a significant effect and few postoperative complications,providing new treatment options for unresectable hilar cholangiocarcinoma that invades blood vessels and bile ducts;2.The PTCD tube can be removed after nano-knife ablation of unresectable hilar cholangiocarcinoma combined with biliary stent implantation to avoid bile loss caused by external drainage and improve the quality of life of patients.