氩氦刀冷冻治疗肺癌的疗效评估

Evaluation of cryoablation therapy for lung cancer

目的探讨氩氦刀冷冻消融治疗肺癌癌的方法、疗效及临床意义。方法对68肺癌患者分三组(<3cm,3～5cm,<5cm),行经皮氩氦刀冷冻治疗治疗,术后给予常规止血、抗炎等处理。治疗后4周开始行CT或DSA随访,并根据肿瘤区CT值变化、实体瘤治疗评价标准(RECIST)及生存率评价氩氦刀冷冻消融的临床疗效。统计数据应用SPSS13.0统计学软件处理,主要采用配对t检验和x2检验进行差异显著性检验,P<O.05认为差异有显著性。生存期分析采用Log-rank法进行,计算其中位生存时间并绘制生存期曲线图.结果68例肺癌患者接受治疗,82.35%的病例(56/68)冰球覆盖率达到90%以上;术前冷冻区CT值为42.09±8.03Hu,术后-7.13±8.25Hu,术后一月为25.70±1.9Hu,各组CT值变化有统计学意义(P<0.01);术后6个月实体瘤评价总有效率为82.35%(56/68),三组间差异无统计学意义(P>0.05)。本组病例68例,随访期间死亡42例,中位生存期13个月,1年生存率50%(34/68)。结论氩氦刀冷冻治疗肺癌创伤小,临床效果较好,无严重并发症.冰球覆盖率、CT值改变、实体瘤治疗评价标准及生存期是评价氩氦刀疗效的有效手段。

Objective To discuss the efficacy and clinical significance of the Cryoablation treatment of lung cancer. Methods 68 patients were divided into 3 groups by the diameter of the tumor （3cm,3～5cm,5cm）,accepted the Argon-helium cryoablation operation respectively,and were dealt with Routine hemostasis and anti-inflammatory treatment after the operation. Four weeks later,each patient was followed up by CT and DSA,and the clinical effect was assessed by the change of the CT value in the tumor area,the RECIST criterion and the Survival statistics. All statistical data were analyzed by SPSS13.0 software mainly through the paired t-test and x2 test. Difference were considered to be statistically significant if P〈0.05. The Long-rank method was applied to get the median survival time and draw the survival curves. Results The coverage of the spherical frozen region in 68 patients was above 90% after the operation,and the overall efficiency judged by the RECIST criterion was 82.35%. The CT value of the frozen area was 42.09±8.03Hu before the operation and -7.13±8.25Hu after it. The CT value had significant difference during each groups（P〈0.01）.The assessment of the RECIST before and after the cryoablation was not statistically significant. The overall assessment of the RECIST 6 months after the operation was 82.35%.In addition,42 of 68 patients died during the follow-up and the median survival time of the 68 patients was 13 months. Conclusion Cryoablation has the virtue of minimally invasive and safety and the evaluation methods of the CT value change and RECIST are meaningful for the assessment of the clinical effect of cryoablation.