ct引导下经皮穿刺氩氦靶向治疗肺癌的临床应用

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1、http://www.paper.edu.cnPercutaneouslungcryotherapybycomputertomographyguidanceWangHongwu,M.D，PhDMinimalInvasiveTumorTherapyCenter MeitanGeneralHospital，Beijing，China Email:whw@endocare.cnAbstractObjective:Todocumentthefeasibilityandsafetyofpercutaneouslungcryotherapy(

2、PLC)inlunglesions.MaterialandMethods:268patientswith318pulmonarymassesunderwent348CT-guided PLCsbetweenAugust,2001andApril,2004using2or3mmcryoprobes.CT-visualized immediateiceformationbeyondtumormarginswascomparedtotumorsizeandlocation. PLCfeasibilityandsafetywasevalu

3、atedforthefollowinglocations:pulmonaryparenchyma (bothcentralandperipheralmasses),invadingorabuttingthechestwall,andcentral structures.Results:AllpatientsunderwentPLCusinglocalanesthesiawithminimalornosedation. IceformationwaswellseenasnegativeHounsfieldunitswithinsof

4、ttissuemasses.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%ofpatients

5、hadslighthaemoptysis,and35.3%hadslightfever,and 29.1%pneumothorax,and10.1%pleuraleffusion.Necroticcavitationlargerthantheoriginal massdevelopedin89%withinoneweekwhichnearlyresolvedby3months(5%).Minimal pulmonaryscarringwasnotedby6months(N=27),85%ofwhichdemonstratedred

6、uced,or stable,tumorsize.WhileCTsuggestedoutcomesby3-6months.Nomajorbleedingor bronchialsequelaewereidentified.Twodeathsindebilitatedpatientsweretemporally relatedand2majorcomplicationsinvolvedbrachialandrecurrentlaryngealnervedamage, thelatterrecoveringspeechin2month

7、s.Conclusions:CT-guidedPLCisapromisingtreatmentformanypulmonaryneoplasmsinnearlyanylocation,aswellasshowingminimalproceduralmorbidityortreatmentsequelae.IntroductionTechnologyassessmentmayoftensufferfromthelackofhistoricalperspectivesfromother subspecialities.Cryother

8、apyisperipherallyknowntomostradiologistsasanintra-operative modality,mostlyusedbyurologistsandgeneralsurgeonsforprostateandl