近日，北京清华长庚医院肝胆胰中心成功开展全球首例局麻下的“微纳刀”肝癌消融临床试验，该手术由北京清华长庚医院院长董家鸿院士团队实施。

 Recently, the Hepatobiliary and Pancreatic Center of Beijing Tsinghua Changgung Hospital has successfully conducted the world's first clinical trial of liver cancer ablation using "Wknife" under local anesthesia. The operation was performed by the team of Academician Dong Jiahong, President of Beijing Tsinghua Changgung Hospital.

本次治疗病例为57岁男性，临床诊断肝内胆管细胞癌局部转移，侵犯肝门伴梗阻性黄疸，主病灶45mm×36mm，已行双侧PTBD（经皮经肝胆管穿刺引流术）减黄处理。由于病灶位于肝门部，紧邻左侧门静脉及胆囊，这里密布肝动脉、门静脉和胆管等重要脉管结构，无法进行手术切除根治，也不适合各种冷/热消融治疗。董家鸿牵头肝胆胰中心多学科讨论后决定，为患者进行具有脉管保护优势的“微纳刀”消融治疗。

The patient undergoing this treatment is a 57-year-old male diagnosed with intrahepatic cholangiocarcinoma with local metastasis, invading the porta hepatis with obstructive jaundice. The main lesion measures 45mm x 36mm and has undergone bilateral percutaneous transhepatic cholangial drainage (PTBD) for jaundice reduction. Due to the lesion's location at the porta hepatis, adjacent to the left portal vein and gallbladder, there are many important vascular and biliary structures such as the hepatic artery, portal vein, and bile ducts that cannot be surgically resected and are not suitable for various cold/hot ablation treatments. After an MDT multidisciplinary consultation at the Hepatobiliary and Pancreatic Center, they decided to use "Wknife," which has the advantage of protecting vascular structures, for the patient's ablation treatment.

整个手术过程中，患者行局部麻醉，在B超联合CT引导下使用“微纳刀”通过单针对病灶区进行消融，消融过程历时15分钟。术中未使用任何肌松剂，也没有采用气管麻醉，患者始终处于清醒状态，可与医生交流。脉冲施加过程中未见肌肉有明显收缩反应，患者也无明显的疼痛的感觉，术后即刻增强CT复查发现，肿瘤病灶区在影像学上已显示全部消融，邻近胆管、血管未见损伤。随后患者安全返回病房，术中术后生命体征平稳、未发现不良反应。

During the entire surgical process, the patient underwent local anesthesia and was treated with the "micro-nano knife" under the guidance of B-ultrasound combined with CT. A single needle was used to perform the ablation on the lesion area, and the ablation process lasted for 15 minutes. No muscle relaxants were used during the surgery, and the patient was conscious and able to communicate with the doctor. No obvious muscle contraction reaction was observed during the process of pulses application, and the patient did not experience any significant pain. After the surgery, an enhanced CT scan was performed and it was found that the tumor lesion had been completely ablated, and there was no damage to adjacent bile ducts or blood vessels. The patient then safely returned to the ward, and no adverse reactions were found in the patient's vital signs during or after the surgery.

不可逆电穿孔消融技术（IRE）通过瞬时高功率的脉冲电场诱导细胞膜产生不可恢复穿孔，进而导致细胞凋亡，可实现消融肿瘤的同时保留肿瘤周围的重要管道结构（血管、胆管和神经）完整性，无热沉效应且在消融区不会有血管周围肿瘤细胞残留。“微纳刀”技术由重庆大学姚陈果教授团队自主创新研发，目前，该技术是最新的一代IRE技术，集成前两代微秒脉冲电穿孔技术（传统IRE）、高频复合脉冲电场电穿孔技术（HF-IRE）优势，并克服了麻醉要求高、肌肉收缩强、布针难、范围小等问题，使得IRE肿瘤消融治疗患者更安全，医生操作更便捷。

Irreversible electroporation (IRE) technology uses high-power, short-duration pulsed electric fields to induce irreversible permeabilization of cell membranes, leading to cell death. It can achieve tumor ablation while preserving the integrity of surrounding vital structures such as blood vessels, bile ducts, and nerves. IRE has no thermal effects and does not leave residual tumor cells around blood vessels in the ablation zone. The "Wknife" technology was independently developed by a team led by Professor Yao Chen-guo at Chongqing University. Currently, it is the latest generation of IRE technology, which integrates the advantages of the previous two generations of microsecond pulse IRE technology (traditional IRE) and high-frequency pulse IRE technology (HF-IRE). It overcomes problems such as high anesthesia requirements, strong muscle contractions, difficult needle placement, and limited range, making IRE tumor ablation treatment safer for patients and more convenient for doctors to perform.

董家鸿团队运用“微纳刀”以及最新研发的单针消融技术，首次实现了IRE技术从“全麻”到“局麻”的跨越，极大地降低了手术操作难度，缩短了整体治疗时间，实现了肝癌局部消融患者受益最大化。这是董家鸿以“清除病灶，保护肝脏，控制损伤”为核心的精准外科治疗理念的体现，也标志着微纳刀可作为一种乏血供型肝癌的最新局部治疗手段，推动我国肝癌微创精准治疗技术走入世界前沿。

The surgical team of the Hepatobiliary and Pancreatic Center of Beijing Tsinghua Changgung Hospital has successfully used the "Wknife" and the latest developed single-needle ablation technology to achieve a breakthrough in the IRE technology, from general anesthesia to local anesthesia. This achievement significantly reduces the difficulty of surgical operations, shortens the overall treatment time, and maximizes the benefits for patients undergoing local ablation for liver cancer. This accomplishment embodies Dong Jiahong's core concept of precise surgical treatment: "clearing lesions, protecting the liver, and controlling damage". Moreover, It also signifies that the Wknife can be used as a new local treatment method for avascular liver cancer, promoting China's minimally invasive and precise treatment technologies for liver cancer to the forefront of the world.