CT引导下氩氦刀联合放射性粒子植入治疗非小细胞肺癌的临床疗效  

Clinical effect of argon-helium knife cryoablation combined with radioactive particle implantation in the treatment of non-small cell lung cancer

作　　者：吴峰[1] 徐红卫[1] 郭辉[1] 权红军[1] 郭彦伟 Wu Feng;Xu Hongwei;Guo Hui;Quan Hongjun;Guo Yanwei(Department of Radiology and Imaging,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Oncology,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院放射影像科,450052 [2]郑州大学第五附属医院肿瘤科,450052

出　　处：《中华老年医学杂志》2021年第2期197-202,共6页Chinese Journal of Geriatrics

摘　　要：目的探讨氩氦刀联合放射性125I粒子植入技术在非小细胞肺癌(NSCLC)患者治疗中的临床应用价值。方法选取2015年1月至2017年1月在郑州大学第五附属医院肿瘤科收治的117例NSCLC患者,根据治疗方式不同分为联合组63例和对照组54例,联合组患者在CT引导下采用氩氦刀联合放射性125I粒子植入进行治疗,对照组仅实施氩氦刀消融治疗,观察治疗前和治疗后1、3、6个月的血常规指标水平、肿瘤标志物水平、肿瘤消融靶区体积及CT值改变;分析两组治疗过程中不良反应情况和疗效评定结果;随访24个月,观察两组的肿瘤复发率和患者生存情况。结果联合组每例患者植入粒子(12.49±4.91)颗,X线曝射量为(123.16±42.75)Gy,治疗前两组患者一般临床资料比较差异均无统计学意义(均P>0.05)。治疗后1、3、6个月,两组患者白细胞计数、红细胞计数、血红蛋白水平差异均无统计学意义(均P>0.05),血小板计数差异存在统计学意义(t=3.154、3.586、2.233,P=0.027、0.019、0.034)。治疗后1个月,两组患者癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)及肿瘤体积水平比较,差异无统计学意义(t=1.065、1.037,P=0.197、0.255);治疗后3、6个月,两组患者CEA、NSE、肿瘤体积水平差异均存在统计学意义(3个月:t=3.142、2.926、4.281,6个月t=4.094、5.382、4.535,均P<0.05)。治疗各监测时刻,肿瘤靶区CT值呈持续降低趋势(均P<0.05)。治疗过程中,联合组患者血小板降低发生率47.6%(30/63)较对照组24.1%(13/54)显著增高(χ^(2)=6.935,P=0.008),两组间术后发热、气胸、肌红蛋白尿、疼痛、出血和恶心呕吐的发生率差异均无统计学意义(均P>0.05)。治疗后6个月,联合组肿瘤缓解率73.0%(46/63)高于对照组48.1%(26/54)。联合组患者生存时间为(21.81±4.31)个月、无复发时间为(20.48±5.76)个月,较对照组(18.93±5.94)个月、(16.93±7.14)个月长,差异均有统计学意义(Log Rankχ^(2)=8.229、9.65Objective To investigate the clinical application value of argon-helium knife cryoablation combined with radioactive seed implantation in the treatment of non-small cell lung cancer(NSCLC).Methods A total of 117 patients with NSCLC admitted to Oncology Department of Fifth Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 were included in our study.And they were divided into the combination group(n=63)treated with CT guided argon-helium knife cryoablation combined with radioactive 125I seeds implantation and the control group(n=54)treated only with argon-helium knife ablation.The changes of blood routine indexes,tumor markers,tumor ablation target volume and CT value were observed before and 1,3,6 months after treatment.Adverse reactions during treatment and the evaluation results of efficacy were compared between the two groups.Patients were followed up for 24 months to observe the recurrence and survival rates between the two groups.Results In the combination group,seeds of(12.49±4.91)were implanted,and the X-ray exposure was(123.16±42.75)Gy.There was no significant difference in general clinical data between the two groups before treatment(P>0.05).At 1,3 and 6 months after treatment,as compared with control group the combination group showed the significantly decreased platelet count(t=3.154,3.586,2.233,P=0.027、0.019、0.034),while,there was no significant difference in white blood cell count,red blood cell count and hemoglobin level between the two groups(all P>0.05).The levels of carcinoembryonic antigen(CEA),neuron-specific enolase(NSE)and tumor volume were significantly lower in combination group than in control group at 3 and 6 months after treatment(t3=3.142,2.926 and 4.281,t6=4.094,5.382 and 4.535,all P<0.05),showing significant improvements of illness.While,the above levels showed no significant differences at 1 month after treatment between two groups(t=1.065,1.037,P=0.197,0.255).At each monitoring time,the CT value of tumor target area showed a steady downward trend(P<0

关 键 词：癌 非小细胞肺 冷冻外科手术 放射性同位素 

分 类 号：R734.2[医药卫生—肿瘤]