肺恶性肿瘤射频消融进展及规范化探讨

The research progress and standardization of radiofrequency ablation for lung malignant tumors

射频消融(RFA)是利用热能导致肿瘤组织凝固坏死。经皮途径RFA治疗肝脏恶性肿瘤的成功,促进了射频消融在肺等其他软组织肿瘤的应用。近年来,许多研究证实了RFA是原发性肺癌和有限的肺转移瘤的安全有价值的治疗技术,临床应用也逐渐增多。理论上,RFA更适合于肺肿瘤的治疗,因为肿瘤周围正常肺实质内的气体能起到一种所谓的绝缘效应,提高能量在肿瘤内的沉积。然而,和其他器官相比,肺消融存在很多不同。本文对肺肿瘤RFA的一些关键问题,包括适应证、围手术期准备、技术要求、并发症防治、影像学随访、以及疗效评价等进行讨论。目前,不能手术治疗的早期肺癌和有限的周围肺组织的转移瘤是RFA的最佳适应证。肺组织的特异性要求使用不同的能量。电极针的准确释放和消融过程的细心操作是提高疗效和避免非靶点重要结构损伤的关键。PET/CT是最准确的术后影像学随访方法,但是术后早期判断肿瘤局部进展仍需进一步验证。对于Ⅰ期非小细胞肺癌和有限的肺转移瘤,RFA术后生存率比较满意。

[Abstract] Radiofrequency ablation （RFA） makes use of thermal energy with a catheter delivery system to cause coagulation necrosis of the tissue. Percutaneous RFA has been well employed for many years in clinical treatment of liver tumors. The great success of RFA in treating hepatic tumors encourages the clinical physicians to use RFA in treating other solid tumors such as lung cancer. For recent years many publications have confirmed that RFA is a safe and valuable treatment option for patients with primary lung cancer or limited pulmonary metastases. This newly-developed modality has been more and more employed for lung tumors in clinical practice. Theoretically, lung tumors are very suitable to RFA because lesion＇s surrounding air within the adjacent normal parenchyma has an insulation effect, thus facilitating energy concentration within the tumor tissue. However, ablation technique used for lung tumors is quite different in many ways when compared with the ablation technique used for the malignancies of other organs. This paper aims to discuss some critical considerations of RFA for lung malignancies, such as indications, perioperative preparations, technical requirements, prevention of complications, follow- up imaging examination, the evaluation of therapeutic efficacy, etc. Presently, RFA is most used for the patients with inoperable early- stage lung cancers or for the patients with small and favorably located pulmonary metastases. The specific features of lung tissue require different power energy. The precise placement of electronic needle and the careful manipulation during RFA procedure are the key points to ensure a satisfactory result and to avoid injury to non-targeted important structures. PET/CT seems to be the most accurate follow-up means, although its role in assessing the local changes of the tumor shortly after RFA needs to be further clarified. For stage I non- small- cell lung cancer and limited pulmonary metastases, RFA provides satisfactory survival rate. （J Intervent Radiol, 2014, 23： 175-180）