微波消融联合无水乙醇＋碘化油化学消融治疗肺部恶性肿瘤的临床研究

Clinical study of microwave ablation combined with anhydrous alcohol and lipiodol chemical ablation in the treatment of pulmonary malignancies

目的探讨微波消融联合无水乙醇＋碘化油化学消融治疗肺部恶性肿瘤的临床疗效及安全性。方法2011年6月至2014年9月原发或复发性周围型非小细胞肺癌及肺转移癌患者56例，共64个病灶，肿瘤直径〉3cm，在局部麻醉或静脉复合麻醉下行CT引导下微波消融联合无水乙醇＋碘化油化学消融治疗，1、3、6、9、12个月分别行增强CT检查，评价疗效，观察术后并发症。结果56例患者均完成治疗，手术时间5～20min，平均（12±1）min。微波消融联合无水乙醇＋碘化油化学消融治疗后即刻CT表现为病灶密度降低，CT值由术前的（51±5）HU降至（32±5）HU。随访12个月，局部控制率为90．6％（58／64），无进展生存率为76．8％（43／56）。22例发热，10例有乙醇反应，8例少量气胸，4例少量胸腔积液，4例呛咳，2例大量气胸，1例少量咯血，无针道转移发生。结论微波消融联合无水乙醇＋碘化油化学消融治疗肺部恶性肿瘤是安全、有效的，为肺部恶性肿瘤的治疗提供了一种新的有效方法。

Objective To investigate the clinical efficacy and safety of microwave ablation combined with anhydrous alcohol and lipiodol chemical ablation for the treatment of pulmonary malignancies. Methods 56 patients with primary or recurrent non-small cell lung cancer and metastatic lung cancer from June 2011 to September 2014 were collected. There were 64 lesions, the tumor＇s diameter was more than 3 cm. The patients were treated with local or intravenous combined anesthesia by CT-guided microwave ablation combined with anhydrous alcohol and lipiodol chemical ablation. All of the patients underwent enhanced CT scanning in 1-, 3-, 6-, 9-, 12-month after operation, the clinical efficacy and safety were observed. Results Operations were completed in all patients. The average operating time was （12±1） min （range： 5-20 min）. After microwave ablation combined with anhydrous alcohol and lipiodol chemical ablation, lower density in the ablated area was observed by CT, the CT value was （51±5） HU before treatment, while it reduced to （32±5） HU after treatment. After follow-up of 12 months, the local control rate was 90.6 % （58/64）, the progression-free survival （PFS） rate was 76.8 % （43/56）. Related complications were observed, including 22 cases with fever, 10 cases with alcohol flush reaction, 8 cases with minimal pneumothorax, 4 cases with minimal pleural effusion, 4 cases with bucking, 2 cases with tension pneumothorax, 1 case with small amount of hemoptysis. No needle track implantation was observed. Conclusion Microwave ablation combined with anhydrous alcohol and lipiodol chemical ablation is effective and safe in the treatment of pulmonary malignancies, which provides a new and effective method for the treatment of pulmonary malignancies.