胸腔镜下射频消融治疗肺部恶性肿瘤

Initial Exploration for the Value of Radiofrequency Ablation of Pulmonary Malignancies by VATS

目的:探讨胸腔镜下射频消融治疗肺部肿瘤的安全性及有效性。方法:49例肺部恶性肿瘤患者接受了胸腔镜下射频消融治疗,其中I期肺癌4例,Ⅳ期16例,胸膜腔播散肺癌21例,肺多发转移性肿瘤8例;病灶直径0.3～6cm。所有患者术后观察各项围手术期参数,并与同期胸腔镜下肺楔形切除患者的围手术期参数比较,验证其安全性。随访了解患者术后总体生存率及死亡原因。结果:49例患者均成功接受射频消融,无术中输血,无一例手术死亡。其中1例伴有矽肺的患者术后出现张力性气胸合并肺炎;1例咯血经止血治疗后好转。手术持续时间56～175min,术中出血量40～200mL,术后住院时间7～35d,与胸腔镜下肺楔形切除术相比,两者围手术期参数之间无明显差异。随访1～35个月,总有效率91.3%。21例单纯胸膜腔转移非小细胞肺癌患者单独计算,其2年生存率为60%。结论:胸腔镜下射频消融治疗肺部恶性肿瘤安全性良好,可操作性强,短期疗效显著,可适用于部分不能耐受手术或无手术指征的非小细胞肺癌和肺转移性肿瘤患者,尤其是对于手术探查中发现已失去手术机会的患者,是一种可供临床选择和值得进一步研究的治疗肺部恶性肿瘤的新方法。

Objective：This study aimed to assess the efficacy and safety of the video-assisted radiofrequency ablation （VARFA） in treating pulmonary malignancies. Methods：Forty-nine patients （29 men, 20 women; age range, 42-80 years）with advanced local lung cancer were treated with VARFA,and compared with video-assisted wedge resection of lung. Followed-up was conducted for 1 to 35 months. The outcomes were evaluated by total remission rate.Results：All 49 patients received VARFA successfully. There was no postoperative mortality. One patient experienced pneumothorax and pulmonitis,one patient experienced hemoptysis. The operative time was 56 to 175 minutes.The Blood loss was 40 to 200 mL.The hospitalization time was 7 to 35 days. There was no significant difference between the peri-operative parameters in both groups. The total remission rate was 91.3%. Conclusion： Video-assisted radiofrequency ablation is a minimally invasive technique that can be used in the management of inoperable pulmonary malignancies and for palliation in selected patients with pulmonary metastases.