PTCD combined with CT-guided microwave ablation for hepatic hilar cholangiocarcinoma：analysis of therapeutic efficacy / 介入放射学杂志

ABSTRACT

Objective To discuss the clinical application of percutaneous transhepatic cholangiopancreatic drainage (PTCD) combined with CT-guided microwave ablation in treating hepatic hilar cholangiocarcinoma. Methods The clinical data of 29 patients with inoperable Ⅲ and Ⅳ type hilar cholangiocarcinoma complicated by obstructive jaundice, who were admitted to authors’ hospital during the period from December 2012 to August 2014, were retrospectively analyzed. The diagnosis of bile duct adenocarcinoma was confirmed by pathology in all patients. Of the 29 patients, both internal and external biliary tract drainage was employed in 19, external biliary tract drainage in 4, and bilateral (both left and right side) bile duct drainage in 6. CT-guided microwave ablation was carried out when the liver function became improved. A total of 46 procedures of microwave ablation were completed in the 29 patients with a mean of 1.5 times per patient. Hepatic function tests, enhanced CT or MR scan were performed 4-8 weeks after treatment. According to mRECIST criteria the therapeutic results were evaluated; the serum bilirubin levels were recorded; the disease progress and the patient’s survival time were followed up. Results One month after the treatment, complete response (CR) was obtained in 15 patients (15/29, 51.7%), and partial remission (PR) in 17 patients (17/29, 58.6%), with the overall efficacy (CR﹢PR) being 82%. After the treatment, one patient developed hepatic metastasis and another one had pulmonary metastasis. Postoperative serum bilirubin levels showed an obvious decrease in all 29 patients. The 6-month, one-year and two-year survival rates were 68.9% (20/29), 31.0% (9/29) and 6.8% (2/29) respectively; the median survival time was 8.9 months and the overall survival time was 11.7 months. Conclusion For the treatment of hepatic hilar cholangiocarcinoma, PTCD combined with CT-guided microwave ablation is minimally invasive, clinically safe and effective.