氩氦靶向治疗肺部肿瘤725例临床研究  

Clinical Study on Targeted Argon-Helium Cryotherapy in Treatment for 725 Cases with Pulmonary Neoplasm

作　　者：冯华松[1] 段蕴铀[1] 聂舟山[1] 李泳群[1] 韩志海[1] 张新红[1] 李毅[1] 孟激光[1] 张燕[1] 温居一[1] 

机构地区：[1]海军总医院,北京100037

出　　处：《中国肿瘤》2007年第11期906-909,共4页China Cancer

基　　金：全军"十一五"医药卫生科研项目(06MB021)

摘　　要：[目的]探讨经皮穿刺氩氦刀靶向治疗肺部肿瘤的临床疗效和安全性。[方法]采用CT引导,对725例肺部肿瘤患者及其816个病灶行经皮穿刺氩氦刀靶向冷冻消融治疗。动态观察肺部肿瘤治疗前后胸部CT、18F-FDG和经皮肺穿刺病理活检等变化、并发症和生存率。[结果]直径<4cm的435个肺内肿块,冰球覆盖肿瘤面积达96%,显效率达97%;直径>4cm的381个肿块,冰球覆盖肿瘤面积为82%,显效率为68%。手术过程安全,无一例死亡。术后患者未发生严重并发症,仅出现少量咯血约占38%,发热35%,气胸25%,胸腔积液6%等轻微副作用,经对症处理可恢复正常。术后1周左右CT影像特征可见肿瘤区域阴影增大,多呈蜂窝空洞样破坏,CT值较冷冻前降低。FDG肿瘤显像示瘤体局部异常放射性浓聚影明显减少。术后3～12个月复查CT示肿瘤明显缩小,部分患者肿瘤消失。肺活检结果显示,术后1个月内肿瘤细胞呈凝固性坏死,3个月后可逐渐吸收或纤维化改变。术后随访0.5年、1年、2年和3年,患者生存率分别为91%、76%、36%和18%,中位生存时间17.8个月。[结论]CT引导下经皮穿刺氩氦刀靶向治疗肺部肿瘤是一种有效、安全的治疗方法,并发症少而轻微。该方法尤其适用于不能手术切除或难于耐受手术,或其他疗法治疗失败的恶性肺部肿瘤患者。[Purpose] To investigate the clinical efficacy and safety of percutaneous pulmonary neoplasm targeted Argon-Helium cryotherapy. [Methods] A total of 725 cases with pulmonary neoplasms and 816 focus were underwent cryotherapy guided by computer tomography （CT）. The chest CT, ^18F-fluorodeoxyglucose （FDG）, lung tissue biopsy were determined and the survival rate and median survival time after follow-up and complications were observed at different stages of cryotherapy. [Results ] Four hundred and thirty-five focus for tumor size 〈4era in diameter were determined and their ice ball surface coverage was 96%, the efficacy rate was 97%, 381 focus 〉4 cm in diameter, ice ball coverage was 82%, efficacy rate was 68%. The cryotherapy was safe, and no death occured during operation.The common side-effects were a little emptysis 38%, fever 35%, pneumothorax 25%, pleural effusion 6%, not serious complications.CT scan showed that necrotic cavitation larger than the original mass within one week,and mostly resolved by 6 months. FDG images showed that cumulative radioisotope of focuses reduced obviously.The focuses density reduced on CT. Necrotic coagulation could be found within 1 month and fibrin scarring 3 months postcryoablation.The survival rates were respectively 91%,76%,36%,18% after follow-up 0.5-,1-,2-, 3-year. The median survival time was 17.8 months after follow-up. [Conclusion] Pereutaneous pulmonary neoplasm targeted argon-helium cryotherapy guided by CT is safe,effective and has little hurt.The effect of cryoablation is mainly associated with clinical stage,tumor size and location. This technique is especially propitious to pulmonary neoplasms that is irresectable or insupportable radiotherapy and chemotherapy.

关 键 词：氩氦刀 冷冻消融 肺部肿瘤 

分 类 号：R734.2[医药卫生—肿瘤]