Yang Shu-Ying, Liu Fen, Liu Yi, Xia Feng-Fei, Fu Yu-Fei
Department of gynaecology and obstetrics, Qilu Hospital of Shandong University, Jinan.
Department of Oncology.
Medicine (Baltimore). 2020 Feb;99(6):e19099. doi: 10.1097/MD.0000000000019099.
We determined the clinical effectiveness and long-term outcomes in patients with distal biliary obstruction (DBO) secondary to pancreatic carcinoma (PC) who were treated by self-expanded metallic stent (SEMS) insertion with or without high-intensity focused ultrasound (HIFU) ablation.From January 2014 to December 2018, consecutive patients with DBO secondary to PC underwent SEMS insertion with or without HIFU ablation in our center. The long-term outcomes were compared between the 2 groups.During the included period, 75 patients underwent SEMS insertion with (n = 34) or without (n = 41) HIFU ablation in our center. SEMS insertion was successfully performed in all patients. Liver function was significantly improved after SEMS insertion in both groups. An average of 2.9 HIFU treatment sessions per patient were performed. Twenty patients (stent + HIFU group: 7; stent-only group: 13) experienced stent dysfunction (P = .278). The clinical response rate to HIFU ablation was 79.4%. The median stent patency was significantly longer in the stent with HIFU group than in the stent-only group (175 vs 118 days, P = .005). The median survival was significantly longer in the stent with HIFU group compared with the stent-only group (211 versus 136 days, P = .004). An Eastern Cooperative Oncology Group (ECOG) Performance Status of 3 (hazard ratio: 0.300; P = .002) and subsequent HIFU ablation (hazard ratio: 0.508; P = .005) were associated with prolonged survival.HIFU ablation following stent insertion can prolong the stent patency and survival for patients with DBO secondary to PC.
我们确定了胰腺癌（PC）继发远端胆管梗阻（DBO）患者接受自膨式金属支架（SEMS）置入术联合或不联合高强度聚焦超声（HIFU）消融治疗的临床疗效和长期预后。2014年1月至2018年12月，在我们中心，连续的PC继发DBO患者接受了SEMS置入术联合或不联合HIFU消融治疗。比较两组的长期预后。在纳入期间，我们中心有75例患者接受了SEMS置入术，其中34例联合HIFU消融，41例未联合HIFU消融。所有患者均成功完成SEMS置入。两组患者SEMS置入后肝功能均有显著改善。每位患者平均接受2.9次HIFU治疗。20例患者（支架+HIFU组7例；单纯支架组13例）出现支架功能障碍（P=0.278）。HIFU消融的临床有效率为79.4%。支架联合HIFU组的支架中位通畅时间显著长于单纯支架组（175天对118天，P=0.005）。支架联合HIFU组的中位生存期显著长于单纯支架组（211天对136天，P=0.004）。东部肿瘤协作组（ECOG）体能状态评分为3分（风险比：0.300；P=0.002）以及随后进行HIFU消融（风险比：0.508；P=0.005）与生存期延长相关。支架置入后进行HIFU消融可延长PC继发DBO患者的支架通畅时间和生存期。
