| Objective:1.To evaluate the safety and efficacy of intraoperative cryoablation in the treatment of advanced pancreatic cancer,and to observe the changes of immune status during perioperative period;2.To explore the application of three-dimensional visualization in cryoablation of pancreatic cancer,and to evaluate the feasibility and effectiveness of preoperative simulated cryoablation.3.To establish a mouse model simulating the Cryo-immunity of pancreatic cancer,and observe the changes of peripheral immunity of tumor bearing mice before and after cryoablation through animal experiments,so as to provide a preliminary basis for the subsequent exploration of cryoablation combined with immunotherapy.Methods:1.The clinical data of 155 consecutive patients with advanced pancreatic cancer treated with intraoperative cryoablation from January 2017 to August 2020 were retrospectively analyzed.The safety and effectiveness of the technique were evaluated by summarizing the surgical methods,comparing the preoperative and postoperative tumor indicators,imaging findings,VAS pain score and other parameters,and counting the perioperative complications and survival prognosis.2.Self developed and upgraded three-dimensional visualization software,and added simulated cryoablation module.12 patients with locally advanced pancreatic cancer undergoing intraoperative cryoablation were performed with preoperative three-dimensional reconstruction and simulated cryoablation,customized operation plan under intraoperative ultrasound real-time monitoring,and three-dimensional reconstruction again after postoperative review.By the comparison of simulated and actual intraoperative plan,ablation volume ratio and other parameters,the evaluation of the application value of three-dimensional visualization in intraoperative cryoablation was made.3.Establish the mice model bearing pancreatic cancer with normal immune function.Observe the changes of peripheral immunity of tumor bearing mice before and after cryoablation by animal experiment.Results:1.All cases were operated safely.Pathological stage: 4 cases of stage ? B,118 cases of stage ? and 33 cases of stage ? according the AJCC standard.The average tumor size was(4.62 ± 1.49)cm.The average operation time was(121.26±43.09)min.There were 34 cases of pancreatic fistula(21.9%),including 28 cases of grade A fistula and 6 cases of grade B fistula.31 cases had gastric emptying obstruction(20.0%),and there was a sustained decrease in CA19-9 level at 2 weeks after the operation(P < 0.05).The pain score was significantly lower than that before the operation(P <0.01).Serum immunological markers increased to peak 1 week post-operatively(P <0.01),and returned to normal after 2 weeks.CT showed that the size of the tumor had decreased(P=0.054).2.The three-dimensional visualization group saved a lot of time of ultrasonic exploration and adjustment,greatly improved the operation efficiency,and the incidence of postoperative complications was lower than that of the control group.In addition,the volume ratio of ablation area in the postoperative review is basically consistent with the theoretical optimal scheme calculated by the computer before the operation,which indicates that the three-dimensional visualization has a good guiding significance for the formulation of intraoperative ablation strategy.3.The mouse model of pancreatic cancer with normal immunity was successfully established and treated with cryoablation.After cryoablation,the total number and activation ratio of dendritic cells in the spleen of mice reached the peak on the 7th day.The proportion of CD3+,CD4+,CD8+ T cells reached the peak on the 14 th day.The serum IFN-? concentration in the cryoablation group was significantly higher than that in the control group on the 7th day.All immune factors were time-dependent.Conclusion:1.Intraoperative cryoablation is safe and effective in the treatment of advanced pancreatic cancer with high symptom remission rate,which can be used as one of the local treatment options for advanced pancreatic cancer.Compared with simple cryoablation,intraoperative combined cryoablation and hyperthermia has more accurate effect and lower complication rate,which may be the development direction of cryoablation for pancreatic cancer.2.Three dimensional visualization is an important means of precision surgery.In the clinical application of intraoperative cryoablation,3D visualization can simulate preoperative ablation,accurately guide the surgical strategy,maximize the volume of ablation coverage and ensure the safety of surrounding important structures.3.Cryoablation can induce the proliferation and activation of dendritic cells in the spleen of pancreatic cancer bearing mice.Dendritic cells can promote the proliferation of peripheral blood cytotoxic T cells through antigen presentation,and induce the differentiation of T cells by secreting IFN-? and other factors,so that the body shows the immune advantage of anti-tumor. |
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