Clinical Application Research Of Nanoknife Ablation In Locally Advanced Unresectable Pancreatic Carcinoma

ObjectivePancreatic carcinoma is a conceal and rapid progress disease,patients have poor prongnosis.The clinical applicability of conventional ablation is finited for it’s disadvantage disadvantage.Recently,an emerging tumor ablation technique ——Nanoknife ablation,is applied to clinical ablation of tumors widely for it’s specific mechanism.This subject is aim to assess the safety and clinical efficacy of Nanoknife ablation in locally advanced unresectable pancreatic carcinoma,and eatimate it’s clinical application value,which is in the hope of furnishing further study with certain references.MethodsProspective analyse the eighteen locally-advanced unresectable pancreatic carcinoma patients who were cured with Nanoknife ablation in the department of hepatobiliary and pancreatic surgery in the Fifth Affiliated Hospital of Zhengzhou University from November 2015 to March 2016,and follow up to March 2017.Collect relevant clinicl dates,and comparative analysis for serum amylase,myocardial enzyme spectrum,fasing glucose and the tumor markers,serum total bilirubin before and after the operation;observe the subside of jaundice and the relief of pain after the operation,and analysis the improvement of the quality of life after the operation according to Quality of life score and Karnofsky performance score(KPS);observe the complications after the operation;carry out the enhanced CT examinations at different times after the operation,appraise the objective postoperative curative effect in accordance with mRECIST standard;census the survival conditions in 1 year after the operation.Results 1 Safety evaluation1.1 Hemodynamic changes in the operation: The life signs such as heart rates and blood pressure were all in the normal range,and there had no arrhythmia related complications.1.2 Serum amylase diversifications before and after the operation:The serum amylase was(52.8±18.1)U/L at 1 day before the operation,it decreased gradually when examinated multiple in postoperative.The cases that the serum amylase is beyond normal ranges transiently after the operation was 14,3 patients were conformed to mild pancreatitis,and the serum amylase was reduced to normal fleetly after inhibition of pancreatitis.The difference of serum amylase was Significant in 1 to 10 days after the operation,p<0.05;the difference was significant when compared preoperative with postoperative 10 days points,p<0.05;there were no difference when compared preoperative with 1 month after the operation,p>0.05.1.3 Myocardial enzyme spectrum before and after the operation:all patients’ myocardial enzyme were in normal range at 1 day before the operation.There had no siginificant elevation when multiple reviews at 1/3/7/10 th day and 1 month after the operation.The myocardial enzyme indexes were not significantly difference between preoperative and postoperative,p>0.05.1.4 Fasting blood glucose changes before and after the operation:The fasting blood glucose was(7.4±0.3)mmol/L at 1 day before the operation(8 patients had type 2 diabetes),10 patients had transient hyperglycemia in preoperative,and depressed to normal graually after conventional treat.The other 8 patients who had type 2 diabates had hypoglycemic therapy on the basis of it’s used methods without the add of medicine,and the blood sugar was controlled well.There had no difference when compared the fasting blood glucose before and after the operation,p>0.05.1.5 Complications in the follow-up period: 3 patients occured mild pancreatitis,each 2 patients arose biochemical leak and gastric emptying disorder,1 case occurred upper gastrointestinal bleedding,and improved rapidly with symptomatic treatment(except 1 upper gasteointestinal bleeding patient died).There had no complications that is related to ablation such as intraperitoneal hemorrhage,intestinal fistula,biliary fistula in the follow-up phase.2 Efficacy evaluation2.1 Tumor markers changes before and after the operation: The CA-199 and CA-242 of 15 patients were all 4 times higher than the normal level,the 3 rest cases were at normal level.The two markers all showed a trend of gradual decline when reviewed at many times after the operation.The CA-199 and CA-242 of 4 patients were down to normal at 10 th days after the operation,and it had no further elevation in the follow up period,5 patients maintained stability after 1 month postoperative,the CA-199 and(0r)CA-242 of 6 patients were increased after 6 month after the operation.The distinction beared significance when contrasted between preoperative and postoperative,p<0.05;there had significant difference when compared at different times in three month after the operation,p<0.05;the changes in 3 to 12 month had no significant difference,p>0.05.2.2 The subside of jaundice and the relief of pain after the operation:?12 patients had moderate or severe jaundice,the other 6 cases had no icteric.The serum total bilirrubin before the Nanoknife ablation was(172±19.9)μmol/l,and decreased to nomal gradually after the operation.The icteric of 12 cases all disappeared completely at 1 month after the operation,and the overall remission rate was 100%.The diffidenct of the total bilirubin between preoperative and postoperative was significant,p<0.05.?All patients had different degrees of abdominal pain or back pain before the operation(VRS):level I(n=13),level II(n=4),level III(n=1)).All patients relieved clearly after the operation except one level III patients,the overall remission was 94.4%.2.3 CT imaging changes in the follow-up phase:The lesion areas appeared irregular low density before the operation,the local area developed liquefaction necrosis and absorbed gradually in three months after the operation.According to the mRECIST standard,the complete remission(CR)was in 3 patients,partial remission(PR)in 9 patients,stabilization disease(SD)in 2 patients,progression disease(PD)in 4 patients until the end of the follow-up period,and the objective response rate was 66.7%.2.4 The quality of life improvement of patients after the operation: The quality of life score and karnofsky performance score(KPS)were all below normal at preporative,when evaluated multiple at different times after the operation,the two were all well improved compared with preoperative.There had all statistical significance when compared of the quality of life score,KPS score before and after the operation,p<0.05.2.5 The survival situations in the follow-up phase: There had no recrudescence at the first 6 months after the operation,and 6 cases reappeared(or transferred)at 6 to 12 month after the operation,and the total recurrence rate was 33.3%.1 patient died from upper gastrointestinal bleeding,4 patients occurred liver metastasis,2 patients occurred extensive abdominal lymph node metastasis,and all died from multiple organ failure.The one year survival rate was 61.1%.Conclusions1、Nanoknife ablation can ablate tumor tissues selectively,reduce the damaging consequence to the surronding structures,it had high safety value and low complications,it can provide new methods for advanced pancreatic cancer which aggress great blood vessels that is unresectable.2、Nanoknife ablation can prolong short-term survival time for those locally advanced unresectable pancreatic carcinoma patients,it has certain short-term efficacy and clinical application value,while the long-term efficacy needs further study.