CT引导下氩氦刀冷冻治疗骨转移瘤的临床疗效

Clinical efficacy of CT guided argon helium knife cryotherapy in treatment of bone metastases

目的观察骨转移瘤患者应用氩氦刀冷冻消融治疗的临床疗效。方法回顾性分析2019年8月至2021年1月厦门医学院附属第二医院收治的骨转移瘤患者58例,根据治疗方案的不同,分为治疗组(n=30例,氩氦刀联合镇痛药物)和对照组(n=28例,镇痛药物治疗)。均于治疗后1周接受双膦酸盐治疗,并于治疗后1周、1个月以及3个月行随访观察。观察指标包括NRS评分、KPS评分、癌痛治疗后临床疗效评价、局部骨转移灶控制情况及不良反应。结果治疗组与对照组的治疗前NRS及KPS评分比较差异无统计学意义(P>0.05)。治疗后1周,治疗组的NRS评分低于对照组,KPS评分高于对照组,差异有统计学意义(P<0.05)。治疗3个月后的癌痛治疗后临床疗效评价显示,治疗组总有效率93.33%,对照组总有效率为57.14%,两组间比较差异有统计学意义(P<0.05)。治疗后定期随访1个月和3个月,影像学检查显示治疗组局部骨转移病灶情况较对照组稳定。治疗组在氩氦刀治疗过程中出现皮肤冻伤1例,局部软组织肿胀4例,血压升高3例,发热2例。两组患者口服阿片类药物镇痛时均发生恶心呕吐、短暂性头晕、尿潴留、便秘,未发生严重不良反应。在唑来膦酸治疗期间均出现短暂性发热、骨关节酸痛、血钙降低。结论氩氦刀冷冻消融技术在治疗骨转移瘤上具有创伤小、效果好、并发症少的特点,对于肿瘤晚期合并骨转移的癌痛患者在姑息对症治疗上起到一定的作用,在临床上有较好的应用前景。

Objective To observe the clinical efficacy of cryoablation using argon helium knife in the treatment of bone metastases.Methods A total of 58 patients with bone metastases treated in the Second Affiliated Hospital of Xiamen Medical College from August 2019 to January 2021 were retrospectively reviewed.According to different treatment regimens,they were divided into the treatment group(n=30,patients treated with argon helium knife combined with analgesics)and the control group(n=28,patients treated with analgesics).All patients were given bisphosphonates 1 week after treatment.All patients underwent follow-up observations at 1 week,1 month,and 3 months after treatment.The NRS score,KPS score,clinical efficacy evaluation after cancer pain treatment,local bone metastasis control,and adverse events were observed.Results There were no significant differences in NRS and KPS scores before treatment between the treatment group and the control group(P>0.05).At 1 week after treatment,the NRS score in the treatment group was lower than that in the control group,and KPS score in the treatment group was higher than that in the control group,with significant differences(P<0.05).The clinical efficacy evaluation after cancer pain treatment at 3 months after treatment showed that the treatment group had a total effective rate of 93.33%,whereas the control group had a total effective rate of 57.14%,with significant differences(P<0.05).The patients were regularly followed up for 1 and 3 months after treatment,and imaging evaluation showed that the local bone metastatic lesions in the treatment group were more stable than those in the control group.There were 1 patient with skin frostbite,4 patients with local soft tissue swelling,3 patients with increased blood pressure and 2 patients with fever during argon helium knife treatment.There were nausea and vomiting,transient dizziness,urinary retention,and constipation in both groups during oral opioid analgesia,but no serious adverse events.There were transient fever,bone and joint soreness,and decreased blood calcium in both groups during zoledronic acid treatment.Conclusion Argon helium knife cryoablation technique is less invasive,effective and has few complications in the treatment of bone metastases.It plays a certain role in palliative symptomatic treatment for cancer pain patients with advanced tumor stage combined with bone metastasis.It is prospective in clinical application.