CT引导下射频消融治疗肺部恶性肿瘤的临床应用

Clinical application of CT-guided radiofrequency ablation for the treatment of pulmonary malignancies

目的探讨CT引导下射频消融(RFA)治疗肺恶性肿瘤的疗效、不良反应和安全性。方法对21例肺恶性肿瘤患者的31个瘤体进行CT引导下RFA治疗,对其中14个瘤体进行2次以上重复消融。术前常规CT引导下经皮穿刺活检或支气管镜检查获取病理学诊断,10例为非小细胞肺癌,其中鳞癌5例,腺癌4例,未分化癌1例,转移性肺癌11例。瘤体直径<5 cm的肿瘤25个(15例),5～8 cm的肿瘤6个(6例)。所有患者术后3、6个月后行增强CT检查评价肿瘤疗效。结果31个肿瘤均顺利完成RFA治疗。肿瘤疗效评估显示:CR 5个,PR 17个,NC 5个,PD 4个,总有效率(CR+PR)为71.0%。术中并发少量气胸8例,液气胸1例。13例术后见暗红色痰,6例术后疼痛,13例术后轻度发热。全部患者未出现其他严重并发症。平均住院时间为5～7 d。结论CT引导下经皮穿刺RFA治疗肺部恶性肿瘤,近期疗效确切,是一种安全、有效、并发症较少的微创治疗方法。

Objective To investigate the clinical efficacy, adverse reactions and safety of CT-guided radiofrequency ablation （RFA） for the treatment of pulmonary malignancies. Methods CT-guided RFA was performed in 21 patients carrying a total of 31 malignant pulmonary lesions. Of the 31 lesions, more than two times of overlapping RFA was done on 14. Preoperative routine CT-guided percutaneous needle biopsy or bronchoscopy was carried out in order to obtain the pathologic diagnosis. Pathologically, non-small cell lung cancer was found in 10 cases, including squamous cell carcinoma （n = 5）, adenocarcinoma （n = 4） and undifferentiated carcinoma （n = 1 ）, while metastatic lung cancer was seen in 11 cases. The diameter of 25 lesions found in 15 patients was less than 5 cm, and the diameter of another 6 lesions found in 6 patients was 5 - 8 cm. Postoperative checkup with enhanced CT scanning was conducted in all patients 3 - 6 months after the procedure to evaluate the therapeutic results. Results CT-guided RFA was successfully accomplished in all patients. Estimation of the results showed that CR was obtained in 5 cases, PR in 17 cases, NC in 5 cases and PD in 4 cases. The overall effeetive rate （CR ＋ PR） was 70.96%. During the operation, mild pneumothorax occmred in 8 cases and hydropneumothorax in one. Postoperative complications included hemoptysis （n = 13）, chest pain （n = 6） and mild fever （n = 13）. No serious complications occurred. The hospitalization days of the patients ranged from 5 to 7 days. Conclusion For the treatment of pulmonary malignancies, CT-guided radiofi＇equency ablation is an effective, safe and minimally-invasive technique with satisfactory short-term efficacy and less complications.