CT引导下经皮穿刺氩氦靶向治疗肺癌的临床应用  

Percutaneous Lung Cancer Cryotherapy Guided by Computer Tomography

作　　者：王洪武[1] 段蕴铀[1] 张燕群[1] 冯华松[1] 聂舟山[1] 颜霞[1] 陆海英[1] 韩志海[1] 田树平[1] 

机构地区：[1]海军总医院氩氦刀肿瘤治疗中心,北京100037

出　　处：《海军总医院学报》2004年第1期8-15,共8页Journal of Naval General Hospital of PLA

摘　　要：目的　观察经皮穿刺氩氦靶向治疗肺癌的安全性和可行性。方法　 2 37例肺癌患者采用计算机体层摄影术引导下经皮穿刺氩氦靶向治疗 2 78次 ,治疗病灶 30 7个。术中用多功能心电监护仪监测心率、血压等的变化 ;术后 5～ 10min再次计算机体层摄影术扫描 ,以观察冰球大小及有无气胸等并发症。术后不同时间分别复查计算机体层摄影术扫描、正电子发射扫描及经皮肺穿刺活检等 ,动态观察肿瘤的变化。结果　 12 4个病灶肺内肿块直径≤ 4cm者冰球覆盖肿瘤面积达 96 7% ,显效率可达 97 1% ;183个病灶肿块直径 >4cm者冰球覆盖肿瘤面积达 79 6 % ,显效率达 6 0 7% ,表明氩氦靶向治疗肺癌的局部疗效主要取决于肿块的大小。手术过程较安全 ,仅有约 2 5 9%的患者有一过性轻度血压升高 ,无 1例术中死亡 ;术后并发症较少 ,仅38 1%患者少量咯血 ,35 3%发热 ,2 9 1%气胸和 6 1%胸腔积液等。术后 1周左右肿瘤增大 ,约 3/ 4可见空洞形成 ,正电子发射扫描亦显示肿瘤中央呈环状改变。术后 1月左右瘤体变小 ,部分缓解 +完全缓解达6 4 % ,空洞减少 (占 38% ) ,正电子发射扫描显示瘤体异常放射性聚集减少 ,靶 /本比值降低。 3月左右 ,部分缓解 +完全缓解达 6 1.4 % ,空洞更趋减少 (仅 2 1% )。 6～ 12月部分缓解Objective To evaluate the feasibility, safety and efficacy of percutaneous lung cancer cryotherapy (PLC) guided by Computer Tomography (CT).Methods Two hundreds and thirty seven patients with lung cancer underwent CT-guided PLC from August, 2001, to April, 2003. CT was conducted to visualize immediate ice formation beyond tumor margins. CT scan, lung tissue biopsy and survival rate were observed at different stage after cryoablation. Results All the patients underwent PIC using local anesthesia with minimal or no sedation. Ice formation was well seen as negative Hounsfield units within soft tissue masses. Tumor size and location were independent determinants of ice coverage: 96.7%(n=124) for masses ≤4 cm in diameter, and 80%(n=183) for masses >4 cm (P<0.01). Only 25.9% of patients had slight hypertension temporally, and no death happened during cryotherapy. Most of the slight side-effects appeared self-limited. No major bleeding or bronchial sequelae were identified. CT scan showed that necrotic cavitation larger than the original mass developed in 77.8% within one week which nearly resolved by 6 months (3.7%). PR+CR was noted by 1～6 months, which demonstrated reduced, or stable tumor size. Necrotic coagulation could be found within 1 month and fibrin scarring postcryo 3 months. The 18 montihs' survive rate was 86% in early stage of lung cancer, 21.3% in Ⅲ stage, 9.1% in Ⅳ stage. Conclusion CT-guided PLC is a promising treatment for lung neoplasm.

关 键 词：氩氦靶向治疗系统 肺癌 计算机体层摄影术 

分 类 号：R734.2[医药卫生—肿瘤] R616.3[医药卫生—临床医学]