用于胰腺囊肿和预防癌症的创新和微创技术
胰腺癌仍然是肿瘤学上最大的临床挑战之一。由于没有可靠的筛查测试和鉴定后的预后不良，因此对这种疾病的新方法的需求在很大程度上还没有得到满足。
In recent years, however, pre-malignant pancreatic cystic lesions have been increasingly discovered in patients undergoing cross-sectional imaging for unrelated reasons. While over half of pancreatic cystic lesions have little to no malignant potential, mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs) can carry a high potential for progression into pancreatic cancer.
发现胰腺囊肿会带来新的困难。根据MATTHEW T. MOYER，医学博士，MS, associate professor of medicine,118金宝搏抽水宾夕法尼亚州健康米尔顿·S·赫尔希医疗中心“通常建议对这些囊肿进行连续的射线照相监测或手术切除，这两者都有显着的局限性。监视是不方便且昂贵的，没有治疗方面，而手术切除与发病率（20％至40％）和死亡率（1％至2％）有关。”
Given these problems, alternative approaches toward cyst management have been explored. Among these, Moyer reports, “endoscopic ultrasound-guided fine needle infusion (EUS-FNI) is an innovative and promising approach. For this, ethanol is infused into the cyst cavity to ablate the pathologic tissue.” The technique has demonstrated modest effectiveness (less than 35 percent) in ablating appropriately selected mucinous lesions1。它也相对安全且耐受性良好，胰腺炎的风险约为3％，这被认为是由于使用酒精。
Moyer指出：“来自韩国的调查人员进一步迈出了一步，并将乙醇与紫杉醇输注配对2。尽管这些有前途的发现，但这种并发症可能与乙醇渗出有关。
To increase the efficacy and safety of this procedure, Moyer and his colleagues are actively investigating an ethanol-free protocol, using EUS-FNI to deliver a chemotherapeutic cocktail tailored specifically for pancreatic neoplasia (paclitaxel, gemcitabine) into the cyst cavity. His group has recently been granted SRC, IRB, and FDA approval to conduct the prospective, randomized, doubleblind, single-center CHARM trial (Chemotherapy for Ablation and Resolution of Mucinous pancreatic cysts).
术前CT扫描显示粘膜病变（左，红色箭头）的魅力患者，在消融后三个月之前几乎完全分辨率（右）
Moyer解释说：“我们希望至少注册七十八名有资格的预立型囊肿的患者。患者将被随机分为对照组，该对照组将接受乙醇灌洗，然后接受紫杉醇/吉西他滨输注，或者是一个实验组，该组将在紫杉醇/吉西他滨输注之前接受盐水灌洗。”患者在三个，六和十二个月的时间内进行了预定的CT监视，以评估囊肿分辨率。
梅奥预计,通过消除乙醇,安全will improve, while choosing chemotherapeutic agents specifically for pancreatic neoplasia will potentially increase rates of cyst resolution. Moyer comments, “We’re excited to launch the CHARM trial and are hopeful that this work will continue the development of EUSFNI techniques that will be more effective with a lower risk profile. If successful, the minimally invasive aspect of the protocol has the potential to become more broadly used for pancreatic cancer prevention in appropriately selected patients.”
MATTHEW T. MOYER，医学博士，MS
宾夕法尼亚州立癌症研究所胃肠病学和肝病学系医学系教授
电话：717-531-4950
电子邮件：mmoyer@pennstatehealth.psu.edu
奖学金：宾夕法尼亚州宾夕法尼亚州赫尔顿·S·118金宝搏抽水赫尔希医学中心的胃肠病学。
居住：Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pa.
医学院：宾夕法尼亚州赫尔希的宾夕法尼亚州立医学院。
在Doximity上与MATTHEW T. MOYER，医学博士
References
- Dewitt J，McGreevy K，Schmidt CM，Brugge WR。EUS引导的乙醇与盐水溶液灌洗胰腺囊肿：一项随机，双盲研究。胃肠道内窥镜检查。2009; 70（4）：710–723。
- 哦，HC，Brugge WR。EUS引导的胰腺囊肿消融：批判性评论。胃肠道内窥镜检查。2013; 77（4）：526-533。