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Objective: In recent years, radiofrequency ablation treatment of malignant tumors with its minimally invasive, safe, effective and reliable so as to get more and more recognition of clinical medical workers and patients, in particular, achieved significant results in the treatment of liver tumors, many scholars Clinical application of radiofrequency ablation treatment of lung cancer, kidney cancer, and achieved good results. Pancreatic cancer is a dangerous disease, the cure rate is low, the prognosis is poor gastrointestinal malignancies. In recent years, the incidence of elevated digestive tract cancer cause of death in the United States has become the first two, the Office of the Cancer Prevention statistics the incidence of pancreatic cancer in China from 1988 to 1997, close to the United States and Europe. The incidence of occult, rapid progress, the prognosis is poor, high mortality, poor quality of life in patients with pancreatic cancer characteristics. Worldwide pancreatic cancer 5-year survival rate of only 5% or less, the worst prognosis of gastrointestinal tumors. Surgical resection is the main treatment, but early diagnosis is difficult, and most patients are diagnosed at advanced stage, with no chance of operation. An important role in the treatment of advanced pancreatic cancer palliative surgery. Whether the application of radiofrequency ablation of unresectable advanced pancreatic cancer, and become a doctor widespread concern in recent years. Through clinical research to explore the radiofrequency ablation in the treatment of advanced pancreatic cancer, the safety and feasibility of a new treatment for advanced pancreatic cancer. Methods: March 2009 to March 2011, I am in the Second Hospital of Hebei Medical University, involved 32 patients with advanced pancreatic cancer line radiofrequency ablation treatment of patients, were confirmed by CT or MRI confirmed advanced pancreatic cancer combined with CA199, intraoperative exploration were unable underwent radical surgical resection or existing liver metastases, postoperative pathology confirmed pancreatic cancer. Analyzed the clinical data of 22 males (68.75%), female 10 cases (31.25%); an average age of 63 years old; abdominal pain in 24 patients (75%), jaundice 4 cases (12.5%), abdominal pain, jaundice (12.5 %); pancreatic cancer in 24 patients (75%), pancreatic cancer eight cases (25%); largest tumor 6cm smallest 3.4 × 3.6cm, an average of 4.3 x 4.5cm; eight cases with liver metastasis (25%); preoperative diabetes in 16 patients (50%); 32 patients were laparotomy intraoperative pancreatic radiofrequency ablation, radiofrequency ablation of liver metastases associated with liver metastasis in 8 patients, surgery simultaneously; 24 cases patients with pancreatic cancer, 22 cases of intraoperative radiofrequency ablation line gastrojejunostomy plus cholangioenterostomy immediately after radiofrequency ablation in 1 patient postoperative bile duct exploration, T-tube drainage, 1 patient radiofrequency ablation of the gallbladder after jejunal consistent cases of pancreatic neck cancer patients, radiofrequency ablation postoperative pancreatic carotid body resection, jejunostomy of the tail of the pancreas. Were given after water fasting, gastrointestinal decompression, intravenous nutrition and antibiotics treatment, to be urine amylase and drainage fluid amylase normal, reduced (lt; 10ml) after eating allocate peritoneal drainage tube. Changes by observing patients blood sugar, blood starch value of intraperitoneal drainage fluid amylase values ??and cited traffic, abdominal pain, improve the situation, changes in postoperative CT CA199 changes, survival time, clinical analysis of radiofrequency ablation treatment of advanced pancreatic the feasibility and safety. Results: 1 postoperative blood glucose changes: 32 routine RF ablation patients, of which 16 cases before surgery confirmed diabetes observed in patients with preoperative, postoperative fasting glucose values ??compare (in diabetic patients with intravenous supplemental high nutrition when sugar pancreas than 3:1 ratio without diabetes, according to a 6:1 ratio), 32 patients with postoperative blood glucose has increased, then decreased gradually, to consider the stress response. 7 days after 16 cases of patients without diabetes fasting glucose can be reduced to preoperative levels; diabetes patients with slightly elevated 7 days after the blood glucose compared with the preoperative, and can be well controlled by subcutaneous injection of insulin and the dosage of insulin is no increased significantly compared with the preoperative. Clinical data analysis are as follows (? X ± s): Preoperative fasting glucose (6.6 ± 1.7) after 1-7 days of fasting blood glucose (11.99 ± 3.8), respectively (11.2 ± 2.9) (10.1 ± 3.5) (9.9 ± 3.2), (9.3 ± 3.4), (8.1 ± 2.7), (6.7 ± 1.3). postoperative did not lead to the occurrence of diabetes. 2 observed line radiofrequency ablation in patients with postoperative serum amylase, abdominal drainage fluid amylase values ??and drainage fluid drainage volume: clinical data are analyzed as follows (? X ± s): Preoperative fasting blood amylase (113.25 ± 176.81), postoperative days 1,3,5,7 serum amylase values ??(119.00 ± 108.57) (44.25 ± 11.41), (38.625 ± 12.68), (25.625 ± 21.51); postoperative days 1, 3, 5, 7 drainage fluid amylase values ??were (1911.875 ± 3951), (321 ± 306.43) (146.625 ± 167.42), (129.5 ± 224.19). After 8 (25%) patients had had blood amylase values ??increased 23 cases (71.875%) had abdominal drainage fluid amylase values ??increased after the first day of peritoneal fluid drainage up to 450ml somatostatin were not given the treatment, the target value quickly approaching normal the drainage fluid drainage volume quickly reduced after 30 days the longest time to extubation seven days, the shortest time to extubation average extubation time was 11.3 days, The median time to extubation 9.5 days, did not observe the occurrence of acute necrotizing pancreatitis. 3 postoperative pain relief in patients: 28 cases (87.5%) patients before surgery showed varying degrees of abdominal pain and lower back pain. Using digital analysis method (NRS), of mild four cases (14.29%), moderate in 12 cases (42.86%), severe in 12 cases (42.86%). After radiofrequency ablation, in addition to three cases pain relief is not obvious, 25 patients with pain have been varying degrees of relief, the overall response rate was 89.3%, other preoperative pain patients 13 cases treated with medication, 10 cases of postoperative disable analgesic medicine, to reduce painkiller medication metering. Clinical data analysis are as follows (? X ± s): preoperative pain scores (5.5 ± 1.81), (1.63 ± 0.86) 4 observed in patients with postoperative radiographic changes after surgery: review of CT showed pancreatic tumor radiofrequency ablation area was necrosis inflammation change enhanced scan tumor strengthen significantly reduced compared with the preoperative. The 5 tumor marker CA199 changes: the group of patients with preoperative CA199 were higher, after review of all the different degrees of decline, of which 8 cases (25%) to the normal range (37u / L). Preoperative clinical data analysis are as follows (? X ± s): CA199 (721.4 ± 315.3). Postoperative CA199 (184.2 ± 290.77) 6 postoperative complications occurred: In addition to the eight cases patients had serum amylase value increased after the 23 patients had abdominal drainage fluid amylase values ??increased, 1 (3.125%) in patients with pancreatic fistula, a month after recovery, patients with pancreatic neck cancer, radiofrequency ablation line pancreatic carotid body resection, pancreatic tail jejunostomy; biliary fistula occurs (see Figure 3) 1 (3.125%), patients with pancreatic cancer, not line cholangioenterostomy, intraoperative bile duct exploration, T-tube drainage. 1 (3.125%) postoperative gastrointestinal bleeding, patients with the head of the pancreas uncinate process carcinoma intraoperative gallbladder jejunostomy, not line gastrojejunostomy. 7 postoperative survival of patients: 1 patient died of gastrointestinal bleeding at 15 days after surgery, one patient died of a serious infection in the abdominal cavity after surgery a month and a half, and 2 patients respectively after 2 months, 3 months died of multiple organ failure due to extensive metastasis. More than 28 cases survived more than six months, the longest one has survived 15 months. Conclusion: through clinical observation of 32 patients with radiofrequency ablation in patients with advanced pancreatic cancer, and prove that radiofrequency ablation treatment of advanced pancreatic cancer is feasible and safe, as long as accurate positioning, intraoperative avoid direct ablation of the great vessels and the pancreatic duct, while the line necessary supplementary measures, such as plus do bilioenteric gastrojejunostomy postoperative to enhance symptomatic treatment and ensure smooth drainage, and more will not cause serious complications. The group of 32 cases radiofrequency ablation results show that postoperative patients with CA199 decline significantly alleviate the pain, prolonged survival of fair treatment effect, but the long-term treatment is ineffective.
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