CT引导肺部多发微小转移瘤同步穿刺活检与射频消融的临床应用价值分析

Clinical application of CT-guided radiofrequency ablation combined with biopsy synchronously to multiple small nodules of lung metastatic tumors

目的探讨CT引导下肺部多发微小转移瘤同步穿刺活检与射频消融治疗的有效性及安全性。方法分析解放军总医院自2016年1至12月肺部多发微小转移瘤患者86例，全部结节直径5～10 mm。根据转移瘤位置分为两组。A组患者51例，病灶位于肺外带，先行穿刺活检后行射频消融；B组患者35例，病灶位于肺部中、内带临近血管结构，先射频后行穿刺活检。A、B两组共144个结节，每次消融结节个数为1～3个不等。两组患者在1～12个月随访复查观察消融病灶消融后变化。结果86例肺部多发微小转移瘤患者均实现了同步穿刺活检与射频消融，成功率为100%，全部病例消融结束后CT扫描显示消融区呈完全涵盖病灶的＂晕＂征。A、B两组在结节数、病理结果阳性率及并发症方面采用秩和检验，P值分别为0.818、0.155和0.452，均〉0.05，这说明两组针对不同位置的结节，采用不同的策略，均可实现安全、有效的诊疗。两组患者1个月后复查均可见肺部消融区涵盖病灶的密度增高影，增强扫描未见强化。3、6个月后复查消融区密度增高影逐渐缩小，12个月后复查可见纤维条索影。结论CT引导经皮穿刺肺部微小结节同步活检与消融安全、有效，对于临近血管结构的肺中、内带结节先消融后活检，可以有效的避免大咳血的发生。

Objective To investigate the therapeutic efficacy and safety of CT-guided radiofrequency ablation （ RFA ） combined with biopsy synchronously to multiple small nodules of metastatic tumors in lung. Method From January 2016 to December 2016, a total of 86 patients in the General Hospital of People＇s Liberation Army with 144 lesions were divide into two groups（ all the lesions were less than 1 era）. Group A with 51 eases located in the lung periphery underwent biopsy prior to RFA. Group B with 35 cases located in the middle and inner side of lung adjacent to the vasculatures contrarily underwent RFA first. The changes of these lesions during the 1 to 12-month were followed up. Results All the procedures were completed successfully. The intra operative CT scanning showed the ablation zones were completely covered by the indicative ＂halo sign＂ respectively. The P value was 0. 818, 0. 155 and 0. 452 respectively, in the number of nodules, pathological results positive rate and complications in the rank and inspection for A, B two groups, which were all higher than 0. 05. Though different strategies according to different location of the nodes, the two groups can achieve safe and effective treatments. All patients in two groups had high density ablation zones on their 1-month post operative CT without enhancement. 3-and 6-post operative CT illustrated a decrease of lesions, 12-month post operative CT showed the lesions turned to fibrous stripes. Conclusion The CT-guided RFA combined with biopsy synchronously to multiple small nodules of metastatic tumors in lung is safe and effective, for the lesions located in the middle or inner side of lung, RFA prior to the biopsy can avoid the massive hemoptysis.