动脉栓塞联合局部消融治疗复发性、难治性胸壁肿瘤  

Arterial embolization combined with local ablation for the treatment of recurrent and refractory chest wall tumors

作　　者：姚全军 胡鸿涛 黎海亮 郭晨阳 赵可 赵亚楠 夏威利 李亚楠 YAO Quanjun;HU Hongtao;LI Hailiang;GUO Chenyang;ZHAO Ke;ZHAO Yanan;XIA Weili;LI Yanan(Department of Minimally-Invasive Intervention,Henan Provincial Cancer Hospital(Affiliated Cancer Hospital of Zhengzhou University),Zhengzhou,Henan Province 450008,China)

机构地区：[1]河南省肿瘤医院(郑州大学附属肿瘤医院)微创介入科,河南郑州450008

出　　处：《介入放射学杂志》2024年第2期135-139,共5页Journal of Interventional Radiology

摘　　要：目的 初步探讨动脉栓塞联合局部消融治疗复发性、难治性胸壁肿瘤的安全性和疗效。方法 回顾性分析11例术后复发、治疗后进展的胸壁肿瘤患者,在原治疗方案的基础上联合DSA引导下动脉栓塞和CT引导下局部消融治疗,观察患者疼痛缓解情况(VAS评分)和术后并发症,并评价治疗疗效。结果 随访率100%,中位随访时间为18.5个月。所有患者均成功实施DSA引导下动脉栓塞术,7例患者9个病灶首程行CT引导下射频消融治疗,2例患者复发再次行射频消融治疗。4例患者5个病灶首程行CT引导下微波消融治疗,1例患者复发再次行微波消融治疗。根据mRECIST评价标准,6、12、18个月有效率(ORR)分别为72.7%(8/11)、45.5%(5/11)、18.2%(2/11),6、12、18个月总生存率分别为81.8%(9/11)、63.6%(7/11)、27.3%(3/11),中位生存期为13.2个月。术后1、3个月VAS评分分别为(2.42±1.25)分、(1.91±1.24)分,明显低于术前(6.78±1.13)分,差异有统计学意义,P<0.05。3例患者术后出现胸腔积液,给予穿刺引流后,胸腔积液消失;2例患者术后发热,对症治疗后发热好转;1例患者治疗后6个月因呼吸衰竭死亡。结论 动脉栓塞联合局部消融可改善胸壁肿瘤患者疼痛症状,延长生存期,而且创伤小、安全性好,可作为复发性、难治性胸壁肿瘤患者一种有效的治疗办法。Objective To discuss the safety and efficacy of arterial embolization combined with local ablation in the treatment of recurrent and refractory chest wall tumors.Methods The clinical data of 11patients with chest wall tumor that recurred after surgery and progressed after treatment were retrospectively analyzed.On the basis of the original treatment regimen,DSA-guided arterial embolization and CT-guided local ablation were employed.VAS score of pain relief and postoperative complications were recorded,and the therapeutic efficacy was evaluated Results All the patients were follow up for a median time of 18.5 months.Successful DSA-guided arterial embolization was accomplished in all patients.Seven patients(9 lesions in total)initially received CT-guided radiofrequency ablation(RFA),and tumor reoccurred in 2 patients,who had to receive RFA once more.Four patients(5 lesions in total) initially received CT-guided microwave ablation(MWA),and tumor reoccurred in one patient,who had to receive MWA again.According to mRECIST criteria,the 6-month,12-month and 18-month objective response rates(ORR) were 72.7%(8/11),45.5%(5/11) and 18.2%(2/11) respectively,the 6-month,12-month and 18-month overall survival rates were 81.8%(9/11),63.6%(7/11) and 27.3%(3/11) respectively,with a median survival time of 13.2 months.The postoperative one-month and 3-month VAS scores were(2.42±1.25) points and(1.91±1.24) points respectively,which were strikingly lower than preoperative(6.78±1.13) points,the differences were statistically significant(P<0.05).After surgery,3 patients developed pleural effusion,which disappeared after puncture and drainage treatment,and 2patients developed fever,which was improved after symptomatic treatment.One patient died of respiratory failure six months after treatment.Conclusion Arterial embolization combined with local ablation can improve the symptoms of pain and prolong the survival time of patients with chest wall tumors.This combination therapy is less traumatic and clinically safe,and it can be used a

关 键 词：动脉栓塞 消融治疗 复发性难治性胸壁肿瘤 

分 类 号：R734.4[医药卫生—肿瘤]