CT引导下射频消融术治疗晚期肺腺癌疗效观察

Effect of CT-guided radiofrequency ablation on advanced lung adenocarcinoma

目的探讨CT引导下射频消融术治疗晚期肺腺癌的临床效果。方法选择郑州大学附属郑州中心医院2017年1月至2018年12月收治的104例晚期肺腺癌患者为研究对象,根据治疗方法将患者分为对照组和观察组,每组52例。对照组患者给予常规化学治疗;观察组患者给予CT引导下射频消融术联合常规化学治疗。流式细胞术检测2组患者治疗前及治疗后1、3个月血T细胞亚群水平,采用美国东部肿瘤协作组(ECOG)评分评估2组患者治疗前、治疗后1、3个月的健康状况;观察2组患者治疗后6、12个月的总有效率、生存率、手术相关并发症及药物不良反应发生率。结果治疗前2组患者血CD4^+、CD8^+水平及CD4^+/CD8^+比值比较差异无统计学意义(P>0.05)。治疗后1、3个月,对照组患者血CD4^+、CD8^+水平、CD4^+/CD8^+比值及ECOG评分与治疗前比较差异无统计学意义(P>0.05)。观察组患者治疗后1、3个月血CD4^+、CD8^+水平高于治疗前,CD4^+/CD8^+比值低于治疗前(P<0.05);观察组患者治疗后1、3个月血CD4^+、CD8^+水平高于对照组,CD4^+/CD8^+比值低于对照组(P<0.05)。治疗前2组患者ECOG评分比较差异无统计学意义(P>0.05)。治疗后1、3个月,观察组患者ECOG评分低于治疗前(P<0.05);且观察组患者ECOG评低于对照组(P<0.05)。治疗后6、12个月,对照组患者治疗总有效率分别为51.92%(27/52)和19.23%(10/52);观察组患者治疗总有效率分别为76.92%(40/52)和34.62%(18/52);治疗后6、12个月,观察组患者治疗总有效率高于对照组(χ^2=7.090、6.528,P<0.05);治疗后6个月,2组患者的生存率均为100%;治疗后12个月,对照组和观察组患者的生存率分别为55.77%(29/52)和82.69%(43/52),观察组患者的生存率高于对照组(χ^2=8.847,P<0.05)。观察组患者术后并发症发生率为36.54%(19/52),经对症治疗后均恢复。观察组和对照组患者常规化学治疗时胃肠道反应和骨髓抑制发生率比较差异无统计学意义(χ^2=7.527、6.613,P>0.05)。结论CT引导下射频消融术治疗晚期肺腺癌患者,疗效佳,安全性高,可提高患者免疫力,改善患者生活质量,延长患者的生存期。

Objective To explore the therapeutic effect of CT-guided radiofrequency ablation for advanced lung adenocarcinoma.Methods A total of 104 patients with advanced lung adenocarcinoma admitted to Zhengzhou Central Hospital Affiliated To Zhengzhou University from January 2017 to December 2018 were selected and they were divided into control group and observation group according to therapeutic method,with 52 patients in each group.Patients in the control group were treated with conventional chemotherapy,while patients in the observation group were treated with CT-guided radiofrequency ablation combined with conventional chemotherapy.The T cell subsets before and at 1 and 3 months after treatment in the two groups of patients were detected by flow cytometry.The Eastern Cooperative Oncology Group(ECOG)score was used to evaluate the health status of the two groups of patients before and at 1 and 3 months after treatment.The overall effective rate and survival rate at 6 and 12 months after treatment were observed and the incidence of operation related complications and adverse drug reactions after treatment were also observed.Results There was no significant difference in the CD4^+,CD8^+level and CD4^+/CD8^+ratio between the two groups before treatment(P>0.05).At 1 and 3 months after treatment,the levels of CD4^+,CD8^+,CD4^+/CD8^+ratio and ECOG score of patients in the control group were not significantly different from those before treatment(P>0.05).In the observation group,the levels of CD4^+and CD8^+at 1 and 3 months after treatment was higher than that before treatment,and the CD4^+/CD8^+ratio was lower than that before treatment(P<0.05).The level of CD4^+and CD8^+in the observation group was higher than that in the control group at 1 and 3 months after treatment,and the ratio of CD4^+/CD8^+was lower than that in the control group(P<0.05).There was no significant difference in the ECOG score between the two groups before treatment(P>0.05).At 1 and 3 months after treatment,the ECOG score of the observation group was lower than that before treatment(P<0.05).The ECOG score of the observation group was lower than that of the control group(P<0.05).At 6 and 12 months after treatment,the total effective rates of the control group were 51.92%(27/52)and 19.23%(10/52),respectively;the total effective rates of the observation group were 76.92%(40/52)and 34.62%(18/52),respectively.At 6 and 12 months after treatment,the total effective rate in the observation group was higher than that in the control group(χ^2=7.090,6.528;P<0.05).After 6 months of treatment,the survival rate of patients in both groups was 100%.At 12 months after treatment,the survival rates in the control group and the observation group were 55.77%(29/52)and 82.69%(43/52),respectively.The survival rate in the observation group was higher than that in the control group(χ^2=8.847,P<0.05).The incidence of postoperative complications in the observation group was 36.54%(19/52),and all patients recovered after symptomatic treatment.There was no significant difference in the incidence of gastrointestinal reaction and myelosuppression between the observation group and the control group(χ^2=7.527,6.613;P>0.05).Conclusion CT-guided radiofrequency ablation for the treatment of patients with advanced lung adenocarcinoma has good efficacy and high safety.It can improve the immunity and the quality of life of patients,and prolong the survival of patients.