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目的 观察经皮穿刺氩氦冻融治疗肺癌的安全性、可行性和近期疗效。方法 2 37例肺癌患者采用CT引导下经皮穿刺氩氦靶向治疗 2 78次 ,治疗病灶 30 7个。术后 5 10min再次CT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CT扫描、肺活检等 ,动态观察肿瘤的变化。结果 肺内 12 4个肿瘤直径 <4cm的病灶 ,冰球覆盖肿瘤面积平均 97% ;183个肿瘤直径>4cm的病灶冰球覆盖肿瘤面积平均 80 %。术中 5 9例患者有一过性轻度血压升高 ,其他并发症较少且症状轻微 ,无一例术中死亡。术后 4～ 10dCT复查 10 8例 ,见肿瘤增大 ,其中 84例有空洞形成 ;2 5～ 35d时复查 5 0例 ,有效率达 6 4 % ;3个月复查 5 7例 ,有效率为 6 1% ;6 12个月复查 96例 ,有效率为 5 0 % ,但残留的肿瘤渐增大。 6例患者术后行肺活检 ,3例于术后 1个月内活检显示消融部位为凝固性坏死组织 ,3例术后 3个月活检显示坏死组织被完全吸收或渐为纤维组织所替代。本组 184例患者术后随访 12个月以上。其中早期肺癌 2 8例、Ⅲ期 10 8例随访 18个月以上 ,分别存活 2 4例 (86 % )、2 3例 (2 1% ) ,Ⅳ期 4 8例 1年的存活率为 9%。结论 氩氦刀治疗肺癌的过程简单、安全 ,并发症较少且较轻 ,近期消融效果与肿瘤大小及部位有关 ,远期疗效有待?
Objective To observe the safety, feasibility and short-term curative effect of percutaneous puncture argon-helium freeze-thawing therapy on lung cancer. Methods Twenty-seven patients with lung cancer underwent CT-guided percutaneous argon-helium targeted therapy for 2 78 times and treated 307 patients. CT scan after 5 10min to observe the size of the ice hockey with or without complications. At different times postoperatively, CT scan and lung biopsy were respectively reviewed to observe the changes of tumor dynamically. Results In the lung, 12 4 tumors with a diameter of <4 cm were covered with an average of 97% of the tumor area covered by ice puck. The area covered by 80% of the tumor area covered by ice puff in 183 tumors with a diameter> 4 cm. During the operation, 59 patients had transient mild hypertension with fewer other complications and mild symptoms. None of them died during operation. Postoperative 4 ~ 10dCT review of 108 cases, see the tumor increased, of which 84 cases of cavity formation; 2 5 ~ 35d review of 50 cases, the effective rate of 64%; 3 months review of 57 cases, the effective rate was 6 1%; 6 12 months review of 96 cases, the effective rate was 50%, but the residual tumor gradually increased. Six patients underwent lung biopsy postoperatively, and 3 patients underwent biopsy within 1 month after operation showing coagulated necrotic tissue. Three biopsies at 3 months postoperatively showed that the necrotic tissue was completely absorbed or gradually replaced by fibrous tissue. The group of 184 patients were followed up for 12 months or more. Among them, 28 cases of early stage lung cancer and 108 cases of stage Ⅲ were followed up for more than 18 months and survived 24% (86%) and 23 (21%) respectively, and the survival rate of 48 cases of stage Ⅳ in one year was 9% . Conclusion Argon-helium knife treatment of lung cancer is simple and safe, with fewer complications and less complications. Recent ablation effects are related to tumor size and location, and long-term therapeutic effect remains.