氩等离子体凝固联合冷冻治疗恶性气道梗阻的临床分析

Analysis of argon plasma coagulation combined with cryotherapy in treatment of malignant airway obstruction

目的探讨经支气管镜介入氩等离子体凝固（APC）联合冷冻治疗中央型肺癌导致的恶性气道梗阻的临床意义及对肿瘤血管的抑制作用。方法对2005年1月至2015年1月我科收治的400例发生气道梗阻的肺癌患者，根据自愿原则分为治疗组（在全身化疗基础上联合支气管镜下APC及冷冻介入治疗）和对照组（只接受化学治疗），对上述不同治疗方案的患者均在治疗后进行长期随访，分析2组患者的中位生存期，并对接受支气管镜下APC联合冷冻治疗的患者在治疗前后进行组织病理学分析和CD31免疫组化染色，了解肿瘤细胞凋亡情况及肿瘤微血管破坏情况。结果治疗组的中位生存期为14个月，而对照组的中位生存期为10个月，差异有统计学意义（t=0．032，P〈0．05）。经支气管镜下APC及冷冻治疗后肿瘤细胞凋亡明显，肿瘤微血管密度为18．31±4．42，治疗前为26．42±6．13，差异有统计学意义（t=0．601，P〈0．01）。结论在全身化疗基础上使用支气管镜下APC联合冷冻治疗中央型肺癌不但能够迅速减除梗阻症状，促进肿瘤细胞凋亡，而且能够破坏肿瘤血管，阻断肿瘤营养供应，从而抑制肿瘤生长，延长患者生存期。

Objective To explore the clinical significance of argon plasma coagulation combined with cryotherapy in the treatment of malignant airway obstruction. Methods 400 patients with malignant airway obstruction in our hospital from January 2005 to January 2015 were investigated, and all patients were divided into control group （chemotherapy group） and treatment group （interventional group）. 200 cases of control group were treated with chemotherapy, while 200 cases of treatment group were treated with argon plasma coagulation combined with cryotherapy. The treatment effectiveness and median survival were analyzed. The histopathological analysis and CD31 immunohistochemical staining were used to evaluate of tumor cell apoptosis and microvascular destruction before and after treatment. Results The median survival was 14 months and ten months in treatment group and control group （ t =0.032, P〈 0.05）. After argon plasma coagulation combined with cryotherapy, apoptosis of tumor cells was significant. The microvessel density was 26.42± 6.13 and 18.31±4.42 before and after treatment （ t= 0. 601, P 〈0.05）.Conclusions On the basis of chemotherapy, argon plasma coagulation combined with cryotherapy can not only quickly relieve obstructive symptoms, promote tumor cell apoptosis, but also destroy the tumor blood vessels, inhibit tumor growth, so as to prolong survival of patients.