摘要
目的 观察经皮穿刺氩氦冻融治疗肺癌的安全性、可行性和近期疗效。方法 2 37例肺癌患者采用CT引导下经皮穿刺氩氦靶向治疗 2 78次 ,治疗病灶 30 7个。术后 5 10min再次CT扫描 ,以观察冰球大小及有无气胸等并发症。术后不同时间分别复查CT扫描、肺活检等 ,动态观察肿瘤的变化。结果 肺内 12 4个肿瘤直径 <4cm的病灶 ,冰球覆盖肿瘤面积平均 97% ;183个肿瘤直径>4cm的病灶冰球覆盖肿瘤面积平均 80 %。术中 5 9例患者有一过性轻度血压升高 ,其他并发症较少且症状轻微 ,无一例术中死亡。术后 4～ 10dCT复查 10 8例 ,见肿瘤增大 ,其中 84例有空洞形成 ;2 5～ 35d时复查 5 0例 ,有效率达 6 4 % ;3个月复查 5 7例 ,有效率为 6 1% ;6 12个月复查 96例 ,有效率为 5 0 % ,但残留的肿瘤渐增大。 6例患者术后行肺活检 ,3例于术后 1个月内活检显示消融部位为凝固性坏死组织 ,3例术后 3个月活检显示坏死组织被完全吸收或渐为纤维组织所替代。本组 184例患者术后随访 12个月以上。其中早期肺癌 2 8例、Ⅲ期 10 8例随访 18个月以上 ,分别存活 2 4例 (86 % )、2 3例 (2 1% ) ,Ⅳ期 4 8例 1年的存活率为 9%。结论 氩氦刀治疗肺癌的过程简单、安全 ,并发症较少且较轻 ,近期消融效果与肿瘤大小及部位有关 ,远期疗效有待?
Objective To document the feasibility,safety and efficacy of percutaneous lung cancer cryotherapy (PLC) guided by Computer Tomography(CT). Methods Two hundred and thirty seven patients with lung cancer underwent CT-guided PLC from August,2001 to April,2003. CT-visualized immediate ice formation beyond tumor margins was compared to tumor size and location. PLC feasibility and safety were evaluated. CT scan,lung tissue biopsy and survival rate were observed at different stages postcryoablation. Results All the patients underwent PLC using local anesthesia with minimal or no sedation. Iceball formation was well seen as negative Hounsfield units within soft tissue masses. Tumor size and location were independent determinants of ice coverage which was 97% ( n =124) for masses <4 cm in diameter,and 80% ( n =183) for masses >4 cm in diameter ( P <0.01). Only 59 patients had transient mild hypertension,and no death occured during cryotherapy. Most of the slight side-effects were self-limited. No major bleeding or bronchial sequelae were identified. CT scan showed that necrotic cavitation larger than the original mass developed in 78% of the cases within one week,and mostly resolved by 6 months (4%). Partial resolution+complete resolution was noted by 1-6 months,which demonstrated reduced or stable tumor size. Necrotic coagulation could be found within 1 month and fibrin scarring 3 months postcryoablation. The survival rate in 18 months was 86% for patients at an early stage of lung cancer,and 21% for patients at stage Ⅲ,while the one year survival rate for patients at stage Ⅳ was 9%. Conclusion CT-guided PLC,with minimal procedure associated morbidity or sequelae,is a promising treatment for lung neoplasm of any stage in nearly any location.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2004年第5期311-314,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
