CT引导下经皮肺穿刺氩氦靶向治疗中央型肺癌

Percutaneous Targeted Cryoablation of Central Lung Cancer by Computer Tomography Guidance

目的:观察经皮肺穿刺氩氦靶向治疗中央型肺癌的疗效、安全性。方法:采用局部麻醉、CT引导下经皮肺穿刺氩氦靶向治疗中央型肺癌。结果:71例中央型肺癌患者76次采用CT引导下经皮肺穿刺氩氦靶向治疗。71例中45例伴肺不张。14例次直径＜4cm的肺内肿块,冰球覆盖肿瘤面积达(89．6±3．5)%,显效率可达91．7%,而62例次直径＞4cm的肿块,冰球覆盖肿瘤面积达(76．3±2．2)%,显效率达65．1%,表明氩氦靶向治疗肺癌的局部疗效主要取决于肿块的大小。手术过程较安全,术中仅有1例患者出现一过性轻度血压下降,无1例术中死亡。术后并发症较少,术后61．8%有少量咯血,47．8%有发热,气胸和胸腔积液各23．7%。术后1周92．3%瘤体增大,73．1%呈空洞样改变;术后1月64．7%瘤体缩小,35．3%还有空洞样改变;3月后,68．7%瘤体进一步缩小,5．9%病灶(＜3cm)完成吸收,56．3%密度变低,仅有5．9%呈空洞样改变。6月以后,还有60%瘤体变小,且密度变低。随访15个月,中位生存期为6个月。根据寿命表法计算,氩氦刀术后半年生存率为66%, 15个月为51%。结论:氩氦刀可用于中央型肺癌的治疗,能减轻症状,延长生命。

Objective： The aim of retrospective review was to assess the efficacy and safety of the percutaneous targeted cryocare surgical system guided by CT in the lung cancer cryoablation. 71 cases with lung cancer underwent cryosurgery between Augest 2001 and November 2002.The percentage of iceball covered lung mass was tested after cryoablation immediately, and the complications,and survive rate were observed. Results： The percentage of iceball coverage lung mass was （89.6 ±3.5）% in 14 cases with the mass 〈4cm in diameter, the efficacy rate was 91.7%, while the percentage of iceball covered lung mass was （76.3 ± 2.2）%, the efficacy rate was 65.1% in 62 cases with the mass 〉 4 cm in diameter, which Suggested fhe local efficacy was depended on the mass in diameter. Post cryo, slight haemoptysis occurred in 61% patients, fever in 47.8%, pneumothorax and pleural effusion in 23.7%, respectively. 92.3% mass enlarged and 73.1% cavity developed after 1 week of cryo. It shrank after 1-3 months. 5.9% cases with the mass 〈3 cm in diameter disappeared after 3.months. 60% was further shrank after 6 months.. A median survive period was 6 months follow-up 15 months. The survive rate was 66% at 6 months and 51% at 15 months. Conclusions： Percutaneous targeted lung cancer cryoablation is a minimally noninvasive, safe treatment in central lung cancer.