Under the leadership of Shen Yanfeng, Director of the Second Department of Oncology, , Affiliated Hospital of Hebei University of Engineering, Deputy Chief Physician Chen Cheng returned from , Zhejiang Provincial Cancer Hospital, , and brought advanced pancreatic tumor diagnosis and treatment technology. Recently, Department of Oncology Second successfully performed a CT-guided pancreatic tumor biopsy on suspected pancreatic cancer patients. The successful implementation of this technology will make it possible for our hospital to obtain histopathological diagnosis before pancreatic tumor surgery, and can provide many patients with suspected pancreatic cancer with pathology basis, making the patients' follow-up treatment more accurate and effective, and better benefit the people in southern Hebei and surrounding areas.
An elderly female patient went to an outpatient clinic of a hospital in the city for poor eating and repeated abdominal pain due to poor food in the past six months. She showed blood-rich tumors in the pancreatic head area, pancreatic neuroendocrine tumor ? Paragonal tumor? other? Histological examination is recommended. Combined with CT images, the lesions in the pancreatic head area are small, with intestinal canal and gastric covering in front, and the puncture path is difficult to avoid. Before the operation, fully consider what complications the patient may have, such as infection, perforation, peritonitis, , bleeding, pancreatic leakage, pancreatitis, etc., and conduct sufficient complication plan treatment before the operation. First, preoperative treatments include fasting water, intravenous nutritional support, enzyme inhibition, intestinal cleaning, etc., and prepare hemostatic drugs such as hemagglutinin , gelatin sponge and other related drugs. In order to ensure the success of the puncture, our department only adopted the coaxial biopsy needle technology for the first time under local anesthesia. While ensuring that there is only one pinhole on the skin and stomach wall, under precise guidance under CT, the biopsy needle was punctured into the pancreatic neck tumor, and a thick needle puncture biopsy was performed, and 7 complete tissue strips were obtained and histopathological results were obtained. The patient was returned to the ward after the operation and did not experience any complications. The total operation time was about 20 minutes, and there was no obvious discomfort in and after the operation. The blood and urinary amylase were checked on the first day after the operation, and the patient returned to liquid diet .
pancreatic cancer is a group of malignant tumors that mainly originate from pancreatic ductal epithelium and acinar cells. It has a high degree of malignancy, is hidden onset, and is difficult to detect early, develop rapidly, and has a short survival time. It is the malignant tumor with the worst prognosis and is called the "king of cancer". Data from the National Cancer Center of China in 2019 showed that pancreatic cancer ranks 10th in the incidence of malignant tumors in China and 6th in the mortality rate of malignant tumors.
The pancreas is located behind the peritoneum, covered by the gastrointestinal tract in the front, blocked by the spine and kidneys, surrounded by the spleen on the left, and intercepted by the liver on the right; the pancreas is extremely rich in blood supply, and the blood vessels around the pancreas head are intertwined and the traffic is a network. It is difficult to completely avoid these blood vessels by puncture, which is prone to bleeding, leaking pancreatic juice, bile duct damage, abscesses, infections and other complications. Among them, the pancreatic juice leak is the most serious. After the injury, a large amount of pancreatic juice leak leaks, which will digest proteins and fat in the abdominal cavity, causing diffuse peritonitis. The consequences are more serious. It is called the most difficult part to puncture, and the diagnosis is very difficult. Therefore, this technology is a "high, refined, and pointed" clinical diagnosis and treatment technology with extremely high entry threshold. At present, many comprehensive tertiary grade A hospitals are rarely carried out. This is also the reason why our hospital can only diagnose through surgery in the past, but its operation is complicated, trauma, high cost, and slow recovery of patients. Therefore, many patients gave up obtaining pathological diagnosis and chose direct treatment, which is difficult to meet the efficient, safe and accurate treatment of patients.
Currently, Department of Oncology Second, Affiliated Hospital of Hebei University of Engineering can undergo various lump puncture biopsy under the guidance of color ultrasound or CT, including common areas, such as liver, lungs, abdominal pelvic cavity, head and neck lumps, chest and abdominal wall and superficial lumps, spinal and limb bone tumors, etc., especially high-risk areas such as pancreas, intramediastinum lumps, paravascular lumps in the neck, retroperitoneal lumps, and high-subtitle punctures such as lumps as small as 1 cm, lung cavity lesions, etc.
Why pancreatic cancer is called the "king of cancer" is because pancreatic cancer is late and grows fast, the diagnosis is difficult ( puncture biopsy is difficult), and the surgical resection rate is low (15%-20%).In the final analysis, it is determined by the special nature of the anatomical part of the pancreas. There are many organs and blood vessels around it covering or entangled, which is extremely difficult to operate and is difficult to cure and remove. Whether it is surgery (prone to residual lesions) or external radiotherapy (dose does not reach the radical dose) it is difficult to treat thoroughly. At present, my Oncology Department II has carried out pancreatic cancer iodine 125 particle implantation surgery. Pancreatic cancer iodine 125 particle implantation is a perfect combination of surgery and radiotherapy. It is similar to surgical resection and can achieve radical cure the radiotherapy dose, achieving the purpose of well controlling pancreatic cancer. At the same time, the patient's trauma is small, with almost no wounds, and the treatment recovery is fast, which is completely in line with the concept of efficient, safe and accurate treatment.
Introduction to Department of Oncology Second Department of Affiliated Hospital of Hebei University of Engineering
