CT引导下经皮肺穿刺氩氦刀靶向治疗肺转移癌

Percutaneous Targeted Metastatic Lung Cancer Cryoablation Guided by Computer Tomography

目的 :观察经皮肺穿刺氩氦刀靶向治疗肺转移癌的可行性和安全性。方法 :采用CT引导下 ,经皮肺穿刺氩氦刀靶向治疗肺转移癌。结果 :4 0例肺转移癌患者 80个病灶接受了氩氦刀治疗。 5 1个直径 <4cm的肺内肿块 ,冰球覆盖肿瘤面积达 98.9% ,显效率可达 10 0 % ,而 2 9例直径 >4cm的肿块 ,冰球覆盖肿瘤面积达 87.0 % ,显效率达 86 .2 % ,表明氩氦刀靶向治疗肺癌的局部疗效主要取决于肿块的大小。手术过程较安全 ,无 1例术中死亡。术后并发症较少 ,4 6 .8%患者术后有少量咯血 ,2 5 .8%有气胸 ,19.4 %有胸腔积液 ,19.4 %术后咳嗽加剧 ,16 .1%有发热。术后 1周 6 6 .7%的瘤体呈空洞样改变 ,体积增大 ;术后 1个月瘤体缩小 ,11.1%病灶完全吸收 ,2 2 .2 %还有空洞样改变 ;3个月后瘤体进一步缩小 ,9.5 %的病灶 (<3cm)完全吸收。绝大多数密度变低 ,仅有 19%呈空洞样改变。 6个月以后瘤体变化不大。随访 15个月 ,中位生存期为 5个月。根据寿命表法计算 ,氩氦刀术后半年生存率为 6 6 % ,15个月为 5 0 %。结论 :氩氦刀比较安全 ,疗效可靠。但长期疗效有待进一步总结。

Objective: To assess the efficacy and safety of the percutaneous targeted cryocare surgical system. Methods: Percutaneous targeted lung cancer was guided by computer tomography. The percentage of iceball covered lung masses was measured after cryoablation immediately, and the complications, and survive rate were observed. Results: 40 cancer patients with 80 lesions underwent cryosurgery in the metastatic lung cancer between Augest 2001 and November 2002. The percentage of iceball covered lung masses was 98.9% in 51 lesions (<4 cm in diameter), the efficacy rate was 100%, while the percentage of iceball covered lung masses was 87%, the efficacy rate was 86.2% in 29 lesions (>4 cm in diameter), which suggested the local efficacy mainly depended on the mass diameter. Slight haemoptysis occurred in 46.8% of patients, fever in 16.1%, pneumothorax in 25.8% and pleural effusion in 19.4% after cryoablation. 66.7% of the masses were enlarged and cavities developed after one week of cryosurgery. They shrank after 1～3 month. 9.5% of lesions (<3 cm in diameter) disappeared after three months. The masses were stable after six months. A median survive period was five months in the follow up fifteen months. The survive rate was 66% in six months and 50% in fifteen months. Conclusion: Percutaneous targeted lung cancer cryoablation is a minimally noninvasive, successful treatment for metastatic lung cancer.