目的 探讨CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌的疗效。方法 选择2013-03至2015-03在CT引导下经皮微波消融治疗26例不能手术切除的巨块型肺癌患者,所有病例诊断均经术前穿刺病理证实,其中鳞癌18例,腺癌7例,腺鳞癌1例。术后即刻、3、6、12个月复查增强CT,评价肿瘤体积缩小及坏死情况,分别于术前与术后1个月采用KPS评分评价患者生存质量,随访时间为12个月。结果 26例32次微波手术均获得成功,其中6例于术后1周行二次微波消融手术。微波消融治疗结束后即刻行CT增强扫描,其中CA 5例(19.2%),PA19例(73.1%),SD 2例(7.7%),总体有效率为92.3%。所有患者瘤体负荷显著减轻,治疗前KPS评分为78.23±11.54,治疗后1个月KPS评分为85.13±10.22(t=-2.282,P＜0.05);消融术前肿瘤最大径为(10.4±1.3)cm,消融术后3、6、12个月肿瘤最大径分别为(7.6±2.4)cm、(6.2±2.8)cm 和(5.7±2.5)cm,与术前比较,差异有统计学意义(F=21.482,P＜0.05)。结论 CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌是一种安全、微创、减瘤效果显著的介入方法,其远期疗效和对患者生存期的影响还有待进一步研究。
Abstract
Objective To evaluate the clinical efficacy of CT guided percutaneous microwave ablation in the treatment of massive lung cancer in the elderly.Methods Between March 2013 and March 2015, 26 patients with unresectable massive lung cancer were treated with CT-guided percutaneous microwave ablation in our hospital. All the cases were diagnosed by preoperative puncture pathology, including 18 cases of squamous cell carcinoma, 7 cases of adenocarcinoma and 1 case of adenosquamous carcinoma. Immediately after ablation and 3, 6 and 12 months after ablation, CT was performed to evaluate the tumor volume reduction and necrosis. The KPS score was used to evaluate the quality of life before operation and 1 month after operation. The follow-up time was 12 months.Results Thirty-two operations of microwave ablation were successfully performed on twenty-six patients, six of whom underwent secondary microwave ablation a week later. CT enhanced scan was performed immediately after microwave ablation treatment. Complete ablation (CA) was found in 5 cases (19.2%), partial ablation (PA) was found in 19 cases (73.1%),and 2 cases (7.7%) were found to be stable (SD). The total efficiency rate was 92.3%.The tumor load was significantly reduced in each of the patients. The KPS score before treatment was 78.23±11.54, compared with 85.13±10.22 (t=13.773, P<0.05) one month after treatment. All the tumors were progressively reduced, with the maximum diameter of the lesion before treatment being (10.4±1.3) cm, (7.6±2.4) cm 3 months after treatment,(6.2±2.8) cm 6 months after treatment and (5.7±2.5) cm 12 months after treatment(F=21.482, P<0.05).Conclusions CT-guided percutaneous microwave ablation is a safe, minimally invasive, and cytoreductive intervention for elderly patients with massive lung cancer. However, its long-term efficacy and influence on the survival of patients should be further investigated.
关键词
CT引导 /
肺肿瘤 /
巨块型 /
微波消融
Key words
CT-guided, lung cancer /
mass /
microwave ablation
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