| ObjectivesThe purpose of this study was to evaluate the short-term safety and clinical efficacy of nanoknife ablation combined with 125I seed implantation in the treatment of non-resectable pancreatic cancer,to evaluate the clinical application value of postoperative complications and patient survival.MethodsTwenty-six patients with locally advanced pancreatic cancer who underwent nanoknife ablation in the department of hepatobiliary pancreatic surgery,the fifth affiliated hospital of zhengzhou university from January 2016 to December 2018 were selected.The study group was treated with nanoknife ablation combined with 125I seed implantation,while the control group was treated with nanoknife ablation alone.Follow-up was conducted until August 2019.Relevant data were collected.Firstly,the changes of myocardial enzyme,serum amylase and the incidence of complications before and after surgery in the two groups were analyzed to evaluate their safety.Then,changes in serum tumor marker ca19-9,VAS score,response rate(RR),disease control rate(DCR),median progression-free survival(PFS)and median survival(OS)were compared between the two groups to evaluate the effectiveness of the two groups.Results1 Safety evaluation1.1 Intraoperative situation:All patients successfully completed the operation,with stable intraoperative vital signs and no arrhythmia or other complications.According to the instrument,the current wave gradually rose to about 50A,indicating complete ablation.1.2 Changes in hemato-biochemical parameters:Myocardial enzyme:The myocardial enzymes of the two groups were normal before and after surgery,with no significant difference(p>0.05).(2)Serum amylase:The serum amylase of the two groups was within the normal range one day before the operation,and the blood amylase of the control group was significantly increased in 2 patients after the operation,showing signs of pancreatitis,which improved after symptomatic treatment.In the study group,1 patient had a slight increase in serum amylase without pancreatitis,which decreased to normal on the 7th day after symptomatic treatment.1.3 Adverse reactions and complications:Both groups of patients showed symptoms of low fever,nausea and vomiting after surgery,which were relieved after symptomatic treatment.Clavien-Dindo was graded at grade 1-2.Postoperative complications such as pancreatic fistula,gastrointestinal hemorrhage and pancreatitis occurred in both groups.According to the grading criteria for pancreatic fistula,2 cases in the control group were grade B pancreatic fistula,while 2 cases in the study group were grade C pancreatic fistula,with no statistically significant difference(P=0.869).In the study group and the control group,there were 5 cases(41.7%)and 4 cases(28.6%)of complications,and there was no significant difference in the incidence of complications between the two groups(P=0.683).2 Efficacy Evaluation2.1 Tumor markers:The serum tumor marker ca19-9 in both groups was higher than normal before surgery,and repeated reexaminations within 3 months after surgery showed a gradual decrease.There was no significant difference in tumor markers between the two groups before and after surgery(p>0.05)2.2.2 VAS score:According to the VAS scoring criteria,there was statistically significant difference in VAS score between the two groups one month after surgery(p<0.05).2.3 Imaging data:Enhanced CT was reexamined 2 weeks,1 month and 3 months after the operation.It was found that the ablation area of the tumor presented uniform and low density,with no obvious enhancement,clear boundaries,and complete development of surrounding large vessels without damage.According to the mRECIST standard,there were 3 cases of CR,4 cases of PR,4 cases of SD,2 cases of PD,RR 57%and DCR 79%in the control group,and 7 cases of CR,3 cases of PR,1 case of SD,RR 83%and DCR 92%in the study group.There was no significant difference in RR and DCR between the two groups(p=0.110,p=0.598).2.4 Survival comparison:The median follow-up time after surgery was 7.7 months(1-15 months),the median PFS in the study group(9.5 months)was higher than that in the control group(7 months),p=0.002,and the median OS group(13 months)was higher than that in the control group(8 months),p=0.030,indicating statistically significant differences.Conclusion1 Nano-knife ablation combined 125I seed implantation can prolong the survival period and tumor progression-free survival period of patients with unresectable pancreatic cancer,and can effectively relieve pain symptoms,providing a safe and effective new clinical treatment idea for patients with large tumor volume and LAPC involving large blood vessels.2 Nano-knife ablation combined 125I seed implantation is of high safety in the treatment of locally advanced pancreatic cancer,without increasing the incidence of complications such as pancreatic fistula and gastrointestinal bleeding. |
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