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CT引导下经皮穿刺氩氦靶向治疗肺癌的临床应用.pdf

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http://www.paper.edu.cn Percutaneouslungcryotherapybycomputertomographyguidance WangHongwu,M.D，PhD MinimalInvasiveTumorTherapyCenter MeitanGeneralHospital，Beijing，China Email:whw@endocare.cn Abstract Objective:Todocumentthefeasibilityandsafetyofpercutaneouslungcryotherapy(PLC)in lunglesions. MaterialandMethods:268patientswith318pulmonarymassesunderwent348CT-guided PLCsbetweenAugust,2001andApril,2004using2or3mmcryoprobes.CT-visualized immediateiceformationbeyondtumormarginswascomparedtotumorsizeandlocation. PLCfeasibilityandsafetywasevaluatedforthefollowinglocations:pulmonaryparenchyma (bothcentralandperipheralmasses),invadingorabuttingthechestwall,andcentral structures. Results:AllpatientsunderwentPLCusinglocalanesthesiawithminimalornosedation. IceformationwaswellseenasnegativeHounsfieldunitswithinsofttissuemasses.Tumor sizeandlocationwereindependentdeterminantsoficecoverage:95.9%formasses≤4cm indiameter(N=140),and80.3%formasses>4cmindiameter(N=208)(p<0.0001).Slight ephemeralhypertensionhappenedin25.9%ofpatientsandnodeathoccurredduring cryoablation.38.1%ofpatientshadslighthaemoptysis,and35.3%hadslightfever,and 29.1%pneumothorax,and10.1%pleuraleffusion.Necroticcavitationlargerthantheoriginal massdevelopedin89%withinoneweekwhichnearlyresolvedby3months(5%).Minimal pulmonaryscarringwasnotedby6months(N=27),85%ofwhichdemonstratedreduced,or stable,tumorsize.WhileCTsuggestedoutcomesby3-6months.Nomajorbleedingor bronchialsequelaewereidentified.Twodeathsindebilitatedpatientsweretemporally relatedand2majorcomplicationsinvolvedbrachialandrecurrentlaryngealnervedamage, thelatterrecoveringspeechin2months. Conclusions:CT-guidedPLCisapromisingtreatmentformanypulmonaryneoplasms innearlyanylocation,aswellasshowingminimalproceduralmorbidityor treatmentsequelae. Introduction Technologyassessmentmayoftensufferfromthelackofhistoricalperspectivesfromother subspecialities.Cryotherapyisperipherallyknowntomostradiologistsasanintra-operative modality,mostlyusedbyurologistsandgeneralsurgeo