CT引导下经皮穿刺适形冷冻消融治疗肺癌的临床分析  

CT-guided percutaneous conformal cryoablation for lung carcinoma

作　　者：肖越勇[1] 吴斌[1] 张肖[1] 李宏军[1] 喻达[1] 李婕[1] 李军[1] 

机构地区：[1]解放军总医院放射科,北京100853

出　　处：《中华放射学杂志》2010年第2期185-189,共5页Chinese Journal of Radiology

摘　　要：目的探讨CT引导监测，经皮穿刺适形冷冻治疗肺癌的安全性、疗效和可行性。方法研究对象为肺癌患者，纳入标准：（1）肺功能差、年龄大不能耐受开胸者；（2）周围型肺癌累及胸膜及胸壁肿瘤而无法彻底切除者；（3）肺癌通过临床综合治疗病灶缩小稳定，但不能消失者；（4）局限性肺癌，有手术切除适应证，但患者拒绝手术治疗者。排除标准：（1）双侧或单侧多发病灶患者；（2）肿块靠近纵隔大血管，预计穿刺途径不可避免地会伤及大血管者；（3）严重肺功能低下，肺最大通气容积〈39％；（4）重度咳嗽，反复出现呼吸困难，不能配合治疗者；（5）肿瘤晚期、明显恶病质及出血倾向者。根据以上标准人选66例共76个病灶进行了冷冻消融，病灶最大径为1．5～16．0cm，全部病灶按照肿瘤体积行17G冷冻探针穿刺适形冷冻。肿瘤最大径〈3．0cm／者采取双针“夹击”冷冻；肿瘤直径3．0～5．0cm者采取多针穿刺适形冷冻；肿瘤最大径〉5．0cm者采取瘤内穿刺适形布针，针距〈1．5cm。患者术后随访6个月至2年。疗效评价采用CT增强扫描，观察病灶大小及强化情况。结果本组18例肿瘤最大径〈3．0cm，术中CT复查显示冷冻范围超过病灶边缘1．0cm以上，病灶局部密度减低，紧邻病灶周围可见窄带状透亮环绕，其外围肺组织密度增高，呈磨玻璃样环绕病灶形成靶征；术后1、3个月复查显示，病灶及邻近肺组织无强化；6个月后复查，扫描局部可见纤维条索影；7例随访时间达2年，其中5例肿瘤无复发和转移，1例术后1年发现纵隔淋巴结肿大，1例出现肿瘤骨转移。22例肿瘤最大径在3．0～5．0cm之间，术后即刻cT复查显示，冷冻冰球覆盖全部病灶，病灶边缘的分叶和毛刺等恶性肿瘤征象消失，病灶体积轻度增大；术后1、3个月复查实性病灶逐渐缩小；9例Objective To investigate the safety, efficacy and feasibility of CT-guided percutaneous conformal cryoablation for lung cancer. Methods The inclusion criteria were ： （ 1 ） Poor respiratory function and aged patients who can not bear the thoracic surgical operation. （2） Peripheral lung cancer involving the pleura and chest wall which can not be resected. （3） Residual tumor after other comprehensive treatment. （4） Focal lung cancer but the patient refused surgical resection. The exclusion criteria were： （ 1 ） Multifocal lesions. （2） Lesion close to mediastinum with possible risk of vessel injury. （3） Severe impairment of pulmonary functions, the maximum voluntary ventilation is less than 39%. （4） Repeated cough or dyspnea, can not cooperate with the procedure. （5） Poor systemic conditions, cachexia or bleeding. Totally, 76 lung carcinoma lesions on 66 patients were treated by CT-guided percutaneous conformal cryoablation using 17 G cryoprobes. The maximum diameters of the tumors ranged from 1.5 cm to 1.6 cm. For the tumors with the maximum diameter less than 3.0 cm. thev were treated bv double-needle clamping crvoablation. For those with the maximum diameter between 3.0 and 5.0 cm, they were treated by multiple-needle conformal cryoablation. For those with the maximum diameter larger than 5.0 cm, they were treated with multiple- needle conformal cryoablation, with the needle distance less than 1.5 cm. All the patients were followed-up 6 to 24 months after the procedure using contrast-enhanced CT to evaluate the tumor size and enhancement. Results For 18 cases with the maximum diameters less than 3.0 cm, CT scan during the procedure showed that the frozen areas extended beyond the edge of the lesions more than 1.0 cm, the lesion attenuated, narrow-band-like encircled translucency around the lesions and ＂target sign＂ with ground-glass density of the peripheral lung tissue. There was no enhancement during the first 1 st,3 rd month follow-up, only fibrosis scar in 6 th month

关 键 词：肺肿瘤 冷冻疗法 

分 类 号：R734.2[医药卫生—肿瘤]