对高度可疑肺癌同时进行CT引导下肺穿刺活检和射频消融的临床研究

A Clinical Study of Computed Tomography Guided Biopsy Followed by Radiofrequency Ablation for Suspicious Lesions in Lung Cancer

目的探讨对可疑肺癌同时进行CT引导下肺穿刺活检(transthoracic needle aspiration,TTNA)和射频消融(radiofrequency ablation,RFA)的可行性。方法回顾性分析2007年7月~2014年4月174例可疑肺癌患者行TTNA和RFA的临床资料,其中47例先行TTNA获得病理后行RFA(异时组),127例TTNA和RFA同时进行(同时组),观察安全性和有效性。结果所有病例均顺利完成TTNA和RFA。严重并发症10例,包括死亡2例,气胸引流8例,胸腔内出血引流1例;轻微并发症46例,包括少量气胸16例,胸痛16例,胸膜反应3例,胸腔积液2例,咳嗽4例,咯血7例,肺内出血2例。异时和同时组间操作相关并发症发生率和肿瘤无进展生存均无统计学差异(P>0.05)。结论同时进行CT引导下肺穿刺活检和射频消融安全可行,适用于不能或拒绝手术的可疑肺癌患者。

Objective To discuss and analyze the probability of transthoracic needle aspiration（ TTNA） followed immediately by radiofrequency ablation（ RFA） of suspicious lung cancer. Methods From July 2007 to April 2014,174 cases received TTNA and underwent RFA subsequently for suspicious lung cancer. Among them,47 cases were given TTNA followed by RFA with pathologic diagnosis,and the rest of 127 cases underwent TTNA and RFA simultaneously. Operation-related complications and clinical results were analyzed. Results The CT-guided biopsy and RFA was successfully completed in all the patients. There were 10 cases of major complications,including death in 2 cases,drainage of pneumothorax in 8 cases and drainage of hemothorax in 1 case. Forty-six patients had developed minor complications without further interventions,including mild pneumothorax in 16 cases,chest pain in 16 cases,pleural reaction in 3 cases,pleural effusion in 2 cases,cough in 4 cases,hemoptysis in 7 cases and pulmonary hemorrhage in 2 cases. The procedure-related morbidity and progression free survival were not statistically different（ P〉 0. 05） between the two groups. Conclusion Simultaneous application of TTNA and RFA is a safe and feasible procedure for suspicious lung cancer patients who are unable to undergo or refuse surgery.