CT引导下射频消融治疗157例肺癌合并气胸并发症的研究

CT-guided radiofrequency ablation for 157 cases of lung cancer complicated with pneumothorax

目的:研究计算机体层成像(computed tomography,CT)引导下射频消融(radiofrequency ablation,RFA)治疗肺癌的气胸发生及其相关风险因素分析。方法:纳入2016年6月—2020年7月于河南省胸科医院经影像学及病理学检查证实的157例(共196个病灶)肺癌患者,进行228次RFA,按照术后第1、3、6个月的原则进行随访,之后每隔6个月复查1次,以胸部增强CT结果来评判消融效果,同时记录患者的临床资料、死亡率及治疗相关的气胸发生率,随后进行数据分析。结果:157例肺癌患者,随访至2021年7月,共27例患者死亡(23例死于肿瘤进展,4例死于肺部感染)。治疗相关的气胸发生共17例(10.82%)。单因素分析结果表明,肿瘤最长径(χ^(2)=2.22,P=0.03)、肿瘤位置(χ^(2)=2.85,P=0.004)、穿刺次数(χ^(2)=2.71,P=0.007)及消融时间(χ^(2)=2.16,P=0.03)是气胸发生的不利风险因素;多因素分析结果表明,肿瘤位置(OR=0.89,P=0.04)、穿刺次数(OR=0.76,P=0.02)是气胸发生的独立风险因素。结论:CT引导下RFA治疗肺癌是一项安全、微创的方法,降低穿刺次数可有效减少治疗相关气胸的发生。

Objective:To study the occurrence of pneumothorax in lung cancer treated by computed tomography(CT)-guided radiofrequency ablation(RFA)and its related risk factors.Methods:A total of 157 patients(196 lesions in total)with lung cancer confirmed by imaging and pathological examination in Henan Chest Hospital from June 2016 to July 2020 were included.And 228 RFA patients were followed up according to the principle of 1,3 and 6 months after surgery,and then re-examined every 6 months to evaluate the ablation effect based on the results of chest enhanced CT.Clinical data,mortality,and treatment-related pneumothorax were recorded,followed by data analysis.Results:Follow-up was performed to July 2021,and 27 patients were died(23 from tumor progression and 4 from pulmonary infection).Treatment-related pneumothorax occurred in 17 cases(10.82%).Univariate analysis showed that the longest diameter of tumor(χ^(2)=2.22,P=0.03),tumor location(χ^(2)=2.85,P=0.004),number of puncture(χ^(2)=2.71,P=0.007)and ablation time(χ^(2)=2.16,P=0.03)were adverse risk factors for the development of treatment-related pneumothorax,while multivariate analysis showed that the location of tumor(OR=0.89,P=0.04)and number of puncture(OR=0.76,P=0.02)were independent risk factors for the development of treatment-related pneumothorax.Conclusion:CT-guided RFA for lung cancer is a safe and minimally invasive method,and reducing the number of puncture can effectively reduce the occurrence of treatment-related pneumothorax.