CT引导下经皮肺穿刺微波消融治疗非小细胞肺癌(36例临床疗效分析)  

Clinical evaluation of CT-guided percutaneous microwave ablation of non-small cell lung cancer

作　　者：谢韬[1] 许军[1] 朱先海[1] 秦汉林[1] 周磊[1] 费一鹏 施长杲[1] 王伟昱[1] 

机构地区：[1]安徽省肿瘤医院肿瘤介入科,安徽合肥230001

出　　处：《影像诊断与介入放射学》2017年第4期314-319,共6页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨CT引导下经皮肺穿刺微波消融(PMAT)治疗非小细胞肺癌(NSCLC)的临床疗效和安全性。方法回顾性分析在我科行PMAT的36例NSCLC患者,分为直径3 cm及以下组(小病变组,19例),直径3~5 cm组(中病变组,11例)和直径大于5 cm组(大病变组,6例),按照RECIST标准对肿瘤的局部疗效进行评价,随访3~50个月,采用Kaplan-Meier法计算生存期,并比较不同肿瘤直径患者微波消融术后1年、2年、3年和4年生存率差异。结果 36例患者均成功完成微波消融术,所有均未出现严重并发症。中位随访24个月内,患者肿瘤局部进展率为27.8%,小病变组和中病变组局部进展率无统计学差异(21.5%比21.7%,χ~2=0.036,P=0.850);大病变组局部进展率明显高于直径≤5 cm患者(χ~2=4.360,P=0.037;χ~2=3.996,P=0.046)。全组患者中位生存时间27个月,1~4年生存率分别为83.3%、55.6%、36.1%和19.4%;小病变组与中病变组中位生存时间均为36个月,1~4年生存率比较无明显统计学差异(89.5%、63.2%、47.4%、26.3%比81.8%、54.5%、45.5%、22.7%,χ~2=0.045,P=0.832);大病变组中位生存时间为15个月,其1年、2年生存率分别为66.7%和33.3%明显低于小病变组和中病变组,差异有统计学意义(χ~2=7.858,P=0.005;χ~2=4.494,P=0.034)。微波消融术中及术后1个月无患者死亡,未见针道内出血、胸腔内出血和针道肿瘤种植转移情况。消融后综合征是最常见并发症(9例),其次为微波消融术中局部疼痛和热感(7例),4例患者术后胸部CT扫描发现轻度气胸。结论CT引导下经皮肺穿刺微波消融术治疗NSCLC疗效确切、安全可靠,有望成为肿瘤直径≤5 cm的不可手术患者的一线治疗手段。Objective To investigate the clinical efficacy and safety of CT-guided percutaneous microwave ablation（PMAT）in the treatment of non-small cell lung cancer（NSCLC）. Methods 36 patients with NSCLC were divided according to the diameters of the tumor masses into small（3 cm, 19 patients）, medium（3-5 cm, 11）, and large（5 cm, 6） groups. The curative effect of local tumor was evaluated using RECIST standard and the survival time was calculated by Kaplan-Meier method after 3-50 month follow-up. The survival rates of patients with different tumor diameters were compared at 1, 2, 3 and 4 years after PMAT. Results All 36 patients underwent PMAT successfully without serious complications. The local tumor progression rate was 27.8% in the me-dian follow-up of 24 months without significant difference（ χ~2=0.036, P=0.850） between the small（21.5%） and medium（21.7%）groups. The tumor progression rate of the large group was significantly higher than that of small（ χ^2=4.360,P =0.037） and medium（χ^2=3.996, P=0.046） groups. The median survival time was 27 months for all patients, 36 months for the small and medium groups,and 15 months for the large group. The overall survival rates were 83.3%, 55.6%, 36.1%, and 19.4% in 1-4 years, respectively.There was no significant difference（χ^2=0.045, P =0.832） in survival rates of small（89.5%, 63.2%, 47.4%, 26.3%） and medium groups（81.8%, 54.5%, 45.5%, 22.7%） at 1-4 years. The survival rates at 1（ χ^2=7.858, P =0.005） and 2（χ^2=4.494, P =0.034）years of the large group were significantly lower than the small and medium groups. At 1 month after PMAT, there was no patient death, intracavitary bleeding, bleeding or tumor seeding along the needle track. Ablation syndrome was the most common complica-tion（9 patients）, followed by local pain and heat（7）, and small pneumothorax（4）. Conclusion CT-guided PMAT is effective and safe as the first-line treatment of patients with NSCLC smaller than 5 cm.

关 键 词：微波消融术 非小细胞肺癌 体层摄影术 X线计算机 生存率 

分 类 号：R730.44[医药卫生—肿瘤] R734.2[医药卫生—临床医学]