氩氦刀冷冻消融治疗肺癌的研究进展

肺癌的治疗方法包括传统外科手术、微创手术、分子靶向药物治疗、化学治疗、放疗等,其中氩氦刀冷冻消融治疗属于微创手术,是一种较为安全、有效的瞬时局部治疗肿瘤的方法,其消融范围可控、可监测,对周围正常组织损伤较小,具有降低肿瘤负荷、缓解肿瘤压迫或直接侵犯引起的疼痛、改善患者生活质量的作用.本文对肺癌的发病状况和常见治疗方法及氩氦刀冷冻消融治疗肺癌的研究进展作一综述.     

氩氦刀冷冻消融治疗老年早期非小细胞肺癌的临床疗效观察

目的:观察氩氦刀冷冻消融治疗老年早期非小细胞肺癌的疗效及安全性。方法:非小细胞肺癌（NSCLC)患者28 例,经病理或细胞学确诊,不愿接受手术或无手术适应证的早期（I期及部分II期）的70岁以上老年患者,全部行CT引导氩氦刀冷冻消融术,观察局部病灶变化、疗效、并发症及生存情况。结果:术后1个月复查CT,按实体瘤评价标准缓解率（CR+PR)为71.4%（20/28）。术后3个月及6个月评价疗效（CR+PR)分别为67.9%和64.3%。1~2年随访过程中7例（25.0%）出现转移,其中5例患者出现纵隔淋巴结转移,2例患者出现远处转移,死亡2例,21例（75.0%）患者未见肿瘤复发或转移征象。所有患者均未出现严重并发症。结论:氩氦刀冷冻消融治疗老年早期非小细胞肺癌疗效较好,安全性高,是老年早期NSCLC治疗的新选择,具有较好的临床应用前景。     

经皮氩氦超低温定向消融治疗肺癌

目的：观察经皮氩氦超低温定向消融治疗肺癌的近期疗效。方法：对无手术适应证的36例Ⅲb期和Ⅳ期肺癌患者，应用低温冷冻系统在CT引导下行经皮氩氦超低温定向消融治疗术。结果：患者术后早期多数出现一过性疼痛，无血、气胸等严重并发症。治疗结束后肿瘤CT值明显下降，治疗后3个月多数患者肿瘤缩小、局部疼痛减轻、KPS评分改善。结论：CT引导下氩氦超低温经皮靶向治疗肺癌是一个安全、有效的局部治疗手段，近期治疗效果良好。     

氩氦刀冷冻消融联合化疗治疗晚期非小细胞肺癌253例

[目的]探讨经皮穿刺氩氦刀冷冻消融联合化疗治疗晚期非小细胞肺癌治疗效果。[方法]对253例ⅢB和Ⅳ期非小细胞肺癌患者分为两组:一组149例单纯接受经皮穿刺氩氦刀靶向冷冻消融治疗,另一组104例氩氦刀冷冻消融联合紫杉醇加卡铂化疗,以胸部CT动态观察治疗前后的变化,随访患者生存时间。[结果]两组手术后即刻冰球覆盖肿瘤面积分别为92%和94%。术后1个月左右CT影像变化,两组之间无显著性差异(P>0.05);术后3个月,联合治疗组CT检查结果临床受益率高于单纯冷冻组。两组中位生存时间分别为10.08±1.02个月和15.10±3.84个月,差异有显著性(P<0.01)。[结论]CT引导下经皮穿刺氩氦刀冷冻消融联合化疗治疗晚期非小细胞肺癌的疗效优于单纯氩氦刀冷冻消融治疗。     

肝脏肿瘤氩氦冷冻消融治疗现状

氩氦冷冻消融术是在医学影像引导下，以液态氩气、氦气为工质，经氩氦刀头输出高压氩气后便组织迅速降温形成冰球，当输出氧气时，冰球在数分钟内解冻并迅速升温，从而造成肿瘤细胞毁损。目前该技术广泛应用于临床肿瘤的治疗，并随着医学科学的进步在不断发展，本文就肝脏肿瘤氩氦刀临床治疗现状做一综述。     

氩氦刀冷冻消融治疗肺癌的临床体会

目的探讨氩氦刀冷冻消融治疗肺癌的疗效。方法回顾性分析采用氩氦刀靶向冷冻消融治疗的12例肺癌患者的临床资料,观察疗效及并发症。结果所有患者均顺利完成手术,术中CT扫描显示总有效率为81．25％,术后3个月CT扫描显示总有效率为68．75％,术后6个月CT扫描显示总有效率仍为68．75％。术后2例（16．67％）出现恶心呕吐,2例（16．67％）出现轻度咳嗽,1例（8．33％）出现痰中带血,1例（8．33％）出现疼痛,3例（25．00％）出现发热,1例（8．33％）出现胸腔积液,1例（8．33％）出现皮下气肿,1例（8．33％）合并肺部感染,经对症处理后均缓解。结论氩氦刀冷冻消融术治疗肺癌疗效显著,副反应小,可改善患者的生存质量,提高生存率。     

氩氦冷冻治疗肺癌对心脏及大血管的影响

目的 观察氩氦冷冻治疗肺癌过程中对大血管的影响。方法 暴露兔颈动脉，直接用氩氦刀冷冻，观察血管的变化。在69例肺癌患者中，行CT引导下经皮穿刺氩氦刀直接冷冻包绕于大血管的肿瘤。结果 经氩氦刀冷冻后，兔颈动脉外观无异常，血流正常。在肺癌患者中也可见经氩氦刀冷冻后，侵犯上腔静脉、主动脉等大血管或心脏的肿瘤内有冰球形成，但无严重副作用发生。结论 氩氦刀治疗对大血管无明显影响。对侵犯心脏和大血管的肺癌，CT引导下氩氦刀治疗是一种可选择的治疗方法之一。     

氩氦刀冷冻消融治疗原发性肝癌的临床研究

[目的]探讨氩氦刀冷冻消融综合治疗中晚期肝癌的疗效。[方法]96例中晚期原发性肝癌分3组观察。第一组用氩氦刀冷冻消融联合TACE治疗37例；第二组单纯用氩氦刀冷冻消融32例：第三组单纯用TACE27例。氩氦刀冷冻消融采用B超／或CT引导经皮穿刺肝肿瘤，共计对97个病灶使用203把氩氦刀二次循环冷冻。[结果]氩氦刀冷冻术后有94.2％（65/69）的患者精神状态得到改善，腹部疼痛症状减轻，恢复快。氩氦刀超低温冷冻联合TACE的近期疗效和12、24个月的生存率明显优于另外两组，中位生存期延长（P＜0．05）。[结论]氩氦刀联合TACE是治疗肝癌有效的方法之一，可望提高肝癌患者生存期和改善生命质量，为丧失手术机会的晚期肝肿瘤患者开辟了一条新的治疗途径。     

氩氦刀联合恩度治疗局部晚期肺癌疗效分析

目的:探讨氩氦刀冷冻消融联合恩度局部应用治疗局部晚期非小细胞肺癌(NSCLC)的疗效.方法:2007年7月至2008年11月,192例中晚期NSCLC,氩氦刀联合恩度局部应用连续治疗102例;单纯用氩氦刀治疗90例.两组中性别、年龄、瘤体大小、肿瘤分期、Kamofsky评分均无显著差异.联合组在冷冻前瘤体内注射恩度15mg;单纯组仅采用冷冻治疗.均采用氩氦刀治疗系统,冻融两个循环.冷冻覆盖范围两组均达到90%-100%.治疗后两周做支气管动脉介入化疗1次.随访2个月对瘤体大小及血流灌注情况进行评价.结果:两组患者的全身状况、食欲、胸闷、咳嗽症状明显好转.肿瘤缩小范围联合组是(35±15)%;单纯组是(25±12)%.两组间有显著性差异(P<0.05).肿瘤区密度:治疗后两组增强扫描,联合组CT值增强前为(29±20)HU;增强后为(31±14)HU;单纯组为(33±22)HU,增强后为(38±16)HU.两组间CT值有显著差异.结论:冷冻消融联合恩度局部应用治疗局部晚期NSCLC有增强疗效的作用.     

CT引导经皮氩氦刀靶向治疗肺癌的临床应用

目的探讨经皮经肺氩氦刀治疗肺癌的临床疗效、CT影像学变化及不良反应。方法62例肺癌患者在CT定位后,经皮穿刺置入行氩氦刀进行治疗。结果经氩氦刀治疗后3个月,胸部CT复查显示52个肿瘤病灶明显缩小(70.2%)。CT显示肿瘤冷冻后呈低密度坏死区,3个月冷冻区实变,12个月冷冻区阴影几乎消失。术后并发症包括气胸、咳嗽、咯血和发热。结论氩氦刀冷冻治疗肺癌创伤小,效果较好,无严重并发症,是治疗肺癌的一种新的有效治疗方法。     

Clinical effects of treatment for lung cancer with double points cryoablation through percutaneous puncture guided by computed tomography

OBJECTIVE To investigate the clinical effects of the application of double points cryoablation through percutaneous puncture for advanced lung cancer patients. METHODS Forty-one patients diagnosed with stage III-IV pulmonary carcinoma were selected for the study. The patients were found to have from 1 to 3 foci of carcinoma, and in each case the disease was limited to one lung. The study patients were divided randomly into 3 groups. There were 16 cases receiving routine chemotherapy and radiotherapy in group I, 13 cases treated with cryoablation at a single point in group II, and 12 cases treated with cryoablation at 2 points simultaneously in group III. The patients in the 2 cryoablation groups also received the same treatment as the patients did in group I. The clinical effects were evaluated within 6 months after treatment, and the survival rate was followed-up for 3 years. RESULTS The clinical effects were improved significantly after treatment in group II and in group III compared with those in group I （P 〈 0.05）, including an enhanced regressive rate of 21%, postponed tumor progression of 50.58% and a clinical benefit rate of 92%. The effective rate of regression in group III was higher than that in group II, 43.59% （P 〈 0.05）, and the 3-year survival rate was 37.25%. Significant differences in side effects were not found between the 2 cryoablation groups. CONCLUSION Cryosurgery ablation at 2 points, simultaneously, and directed at I foci might improve the effects of treatment and the prognosis of lung cancer patients, when used in combination with routine treatment.     

肝癌氩氦刀治疗效果评价展望

随着肝癌发生机制研究的深入及肿瘤治疗技术的进步, 对肝癌的治疗也有了一定的进展。近年来, 氩氦刀治疗肝癌作为一种新的治疗方法, 在临床上逐渐得到推广应用。然而肝癌氩氦刀治疗后, 如何经济又实用的判断其治疗疗效, 一直是困扰临床应用的实际问题。本文拟就国内外相关研究进展进行探讨。     

The role of computed tomography in the diagnosis of lung cancer

The paper discusses the data on 229 cases of lung pathology including 85 with cancer. Sensitivity and specificity were 89.4 and 86% for standard X-ray procedures and 91.8 and 90.3% for computed tomography, respectively. Combined application of the methods was followed by a rise in the parameters to 94.1 and 93%, respectively. Computed tomography proved useful for early detection of lung metastases.     

多层螺旋CT三维重建对胃癌术前分期的价值

目的:通过对胃癌患者实施多层螺旋CT（multi-slice spiral computed tomography,MSCT）及三维重建后进行术前分期,评价其准确性及对胃癌治疗方式选择的价值。方法:2010年8月-2011年10月在中国医科大学附属盛京医院胃肠、营养外科住院,并经术前胃镜及病理检查确诊的胃癌患者64例。全部患者在术前一周内进行64层螺旋CT平扫及双期增强扫描,将获得的扫描影像数据以1.0 mm薄层重建后传至后期工作站。由2名从事腹部CT工作5年以上的高年资影像科医生应用工作站软件对图像作多平面重建（multi-planar reformations,MpR)。再由1名从事腹部CT工作5年以上的高年资影像科医生和1名高年资胃肠外科医生在不明了胃镜结果的情况下在PACS上通过协商读片,分别分析MSCT横断位及MpR图像。对照手术后的病理结果,计算MSCT横断位和MpR图像对胃癌的检出率和T、N分期的准确性;比较MSCT横断位和MpR图像对胃癌T、N分期准确性。结果:对原发胃癌病灶的检出率,MSCT横断图像和MpR图像分别是90.63%(58/64)和95.31%(61/64)。与组织病理学分期比较,依据MpR图像的T分期准确率为85.25%(52/61),高于依据MSCT横断位图像的65.57%(40/61)(P=0.012);而MpR图像的N分期准确率为73.77%(45/61),与MSCT横断位图像的67.21%(41/61)比较,其差异无统计学意义(P=0.427)。结论:MSCT横断位结合MpR图像能更清晰显示肿瘤形态、大小以及与邻近结构的关系,能较为全面和准确地观察胃癌淋巴结的位置、大小及数量,更好地进行术前分期,有助于胃癌治疗方式的选择。     

多排螺旋CT显示支气管与外周肺癌关系的价值

目的 研究多排螺旋CT(MSCT)显示支气管与外周肺癌关系中的价值。方法 采用MSCT对53例外周肺癌行层厚为0．5mm的容积靶扫描,通过多层面或曲面重建(MPR or CMPR)以及表面遮盖显示(SSD)的方法,显示支气管与外周肺癌的关系。将结果与手术标本、病理切片对照。结果 (1)全部第3—7级支气管均全程清晰、完整的显示,肿瘤与支气管有关系者：30例腺癌中29例(96．7％),17例鳞癌中13例(76．5％)。(2)肿瘤-支气管关系分为4型：Ⅰ型：支气管被肿瘤截断;Ⅱ型：支气管进入肿瘤锥状中断;Ⅲ型：支气管在肿瘤内保持通畅;VI型：支气管紧贴肿瘤边缘走行,形态正常或受压移位。(3)Ⅰ型发生率为58．5％(31／53),其中鳞癌略多于腺癌;Ⅱ型和Ⅲ型均为15．1％(8／53),仅见于腺癌;Ⅳ型为28．3％(15／53),腺癌略多于鳞癌。(4)与第4级支气管相关的肿瘤,鳞癌多于腺癌;与第6级支气管相关的肿瘤,腺癌多于鳞癌。结论 采用MSCT,超薄层靶扫描后行MPR、CMPR和SSD重建能准确地显示肿瘤-支气管关系,反映一定的病理改变。     

The Value of Multislice Spiral Computed Tomography in Demonstrating the Relationship between Bronchial and Peripheral Lung Cancer

OBJECITVE To investigate the value of multislice spiral computed tomography (MSCT) in demonstrating the relationship between bronchial and peripheral lung cancer.METHODS MSCT was used to conduct volumetric targeted scans of 0.5 mm collimation for 53 cases of peripheral lung cancer and to demonstrate the relationship between bronchial and peripheral lung cancer by multiplanar reconstrUctions(MPR) images, curved multiplanar reformations(CMPR) and surface shaded display(SSD). The results were compared with macroscopic and microscopic specimens.RESULTS 1) All the bronchi at the 3rd to 7th order were displayed clearly and completely with this CT protocol. The tumors that were related to the bronchus included 29 (96.7%) adenocarcinomas and 13 (76.5%) squamous-cell carcinomas. Statistical analysis showed that there was no significant difference between the two groups (x2 =2.8, P ＞0.05). 2) The tumorbronchus relationship was divided into four subtypes, i.e. type Ⅰ: the bronchus was obstructed by a tumor, type Ⅱ: the bronchus was obstructed when penetrated by a tumor with tapered narrowing; type Ⅲ: the bronchial lumen shown within the tumor was unobstructed and intact, type Ⅳ: the bronchus ran at the periphery of a tumor, with an intact or narrowed lumen.3) Type Ⅰ occurred in 58.5% (31 cases), in which squamous-cell carcinoma was slightly more common than adenocarcinoma. Both type Ⅱ and type Ⅲ were seen in 15.1%(eight cases of each), of which all were adenocarcinomas. The incidence rate of type Ⅳ was 28.3% (15 cases), of which adenocarcinoma was slightly more frequent than squamous-cell carcinoma. 4)Squamous-cell carcinoma was more common than adenocarcinoma in the tumors in the fourth-order bronchus, whereas adenocarcinoma was more common than squamous-cell carcinoma in tumors with a relationship to the sixth-order bronchus.CONCLUSION MSCT with volumetric targeted scans of ultra-thin sections were conducted followed by MPR,CMPR and SSD reconstruction. This procedure can accurately demonstrate the relationship between the nature of tumors and bronchus and thereby to some extent reflect pathological changes.     

Evaluation of computed tomography numbers for treatment planning of lung cancer

Computerized tomography numbers (CTN) were evaluated in 32 computerized tomography scans performed on patients with carcinoma of the lung, with the aim of evaluating CTN in normal (lung, blood, muscle, etc) and pathologic tissues (tumor, atelectasis, effusion, post-radiation fibrosis). Our main findings are: 1. Large individual CTN variations are encountered in both normal and pathologic tissues, above and below mean values. Hence, absolute numbers are meaningless. Measurements of any abnormal intrathoracic structure should be compared in relation to normal tissue CTN values in the same scan. 2. Tumor and complete atelectasis have CTN basically similar to soft tissue. Hence, these numbers are not useful for differential diagnosis. 3. Effusions usually have lower CTN and can be distinguished from previous situations. 4. Dosimetry based on uniform lung density assumptions (i.e., 300 mg/cm³) might produce substantial dose errors as lung CTN exhibit very large variations indicating densities well above and below this value. 5. Preliminary information indicates that partial atelectasis and incipient post-radiation fibrosis can have very low CTN. Hence, they can be differentiated from solid tumors in certain cases, and help in differential diagnosis of post radiation recurrence within the radiotherapy field versus fibrosis.     

The value of computed tomography in the management of bladder cancer.

In an attempt to improve the radiotherapeutic management of patients with bladder carcinoma, we have added computed tomography (CT) scanning of the pelvis and abdomen to conventional evalution, including cystoscopy with bimanual examination under anesthesia. Sixty consecutive new patients were studied from July 1976 to November 1977. Operative findings were correlated with CT scans in 17 patients; 13 had exploration of the abdomen and pelvis at the time of ileal loop diversion and 3 at the time of segmental resection, before irradiation. Only periaortic node biopsy specimens were obtained in the 17th patient. The potential value of CT scanning was investigated in both groups. We conclude that CT scanning: (1) is of value in defining the extent of involvement in the bladder and perivesical tissues, in pelvic soft tissues and nodes, in periaortic nodes, and in fixation to bone; (2) provides for more accurate staging than was possible previously by non-invasive techniques; (3) allows for technically simpler display of multiple 2-dimensional computerized radiation therapy treatment plans, thus simulating 3-dimensional planning; (4) allows the tumor response to irradiation to be followed with time, facilitating surgical planning; and (5) permits detection of residual and recurrent tumor.