经电磁导航支气管镜微波消融在不可手术高危肺结节中的临床应用

Clinical utility of electromagnetic navigation bronchoscopy-guided microwave ablation in patients with inoperable high-risk pulmonary nodules

目的探讨利用电磁导航支气管镜技术对不可外科手术的高危肺结节进行微波消融的临床应用价值和安全性。方法回顾性分析2019年12月至2020年9月在复旦大学附属中山医院诊断高危肺结节并进行电磁导航支气管镜检查和微波消融治疗9例患者的临床资料,其中男6例、女3例,年龄72.0(59.5,77.0)岁。分析患者临床特征、治疗的有效性与安全性。结果 9例患者共12处高危肺结节进行了电磁导航支气管镜检查和微波消融治疗,所有患者均合并有慢性基础疾病,无法进行胸外科手术的原因主要有肺功能无法耐受(55.6%)、其它系统基础疾病(33.3%)、多叶段病灶(22.2%)、个人意愿(22.2%)、高龄(11.1%)等。CT影像显示肺结节中位直径13.5(9.5,22.0)mm,结节距离胸膜中位距离5.3(1.8,16.3)mm。所有结节导航规划路径到达后并使用径向超声探头进行确认,活检组织进行快速现场细胞学评估。术后病理诊断腺癌4处、非小细胞肺癌-非特殊型1处、炎症性病变2处、未见异型者5处。微波消融成功率83.3%(10/12),其中脱靶2处病灶均再次进行了CT引导下经皮穿刺消融。中位住院时间3.0(2.0,3.0)d,术后短期随访未出现并发症。结论对于不可外科手术的高危肺结节患者,利用电磁导航支气管镜联合微波消融治疗安全有效,为临床诊疗提供了新的选择。

Objective To explore the clinical utility and safety of electromagnetic navigation bronchoscopy(ENB)-guided microwave ablation(MWA) in the patients with inoperable high-risk pulmonary nodules. Methods Clinical data of patients who were diagnosed with inoperable pulmonary nodules highly suspected as malignant tumors and treated with ENB-guided MWA in Zhongshan Hospital, Fudan University from December 2019 to September 2020 were retrospectively collected and analyzed to evaluate the efficacy and safety of the procedure. There were 6 males and 3 females aged 72.0(59.5-77.0) years. Results Totally ENB-guided MWA was performed in 9 patients with 12 lesions. All patients suffered from at least one chronic comorbidity. The inoperable reasons included poor pulmonary function(55.6%), comorbidities of other organs which made the surgery intolerable(33.3%), multiple lesions in different lobes or segments(22.2%), personal wills(22.2%) and advanced in age(11.1%). The median diameter of nodules was 13.5(9.5-22.0) mm and the median distance from the edge of nodules to pleura was 5.3(1.8-16.3) mm. Bronchoscope maneuver to the targeted lesions was manipulated according to navigation pathway under visual and X-ray guidance and confirmed with radial ultrasound probe. Rapid on-site evaluation also helped with primary pathological confirmation of biopsy specimen. Among all the lesions, 4 adenocarcinoma, 1 non-small cell lung cancer-not otherwise specified and 2 inflammatory lesions were reported in postoperative pathological diagnosis, while no malignant cells were found in 5 specimens. The ablation success rate was 83.3%(10/12). For the two off-targeted lesions, percutaneous ablations were performed as salvage treatment subsequently. The median hospitalization time was 3.0(2.0-3.0) days and no short-term complications were reported in these patients. Conclusion ENB-guided MWA is a safe and effective procedure for patients with high-risk pulmonary nodules when thoracic surgery cannot be tolerated.