经皮联合支气管腔内冷冻消融治疗中央型肺癌的研究分析

目的探讨联合经皮及经气管镜引导腔内冷冻消融治疗中央型肺癌的疗效。方法47例不可切除的中央型肺癌患者（22个气管内型病灶,26个气管壁型病灶,21个气管外型病灶）共行69次经皮、经气管镜引导腔内冷冻消融治疗,统计无进展生存期（PFS）,分析冷冻治疗后的PFS与肿瘤生长部位、病理类型及分化程度关系。结果气管内型肿瘤PFS（8±4个月）明显低于气管壁型肿瘤（13±6个月）（P〈0．05）及气管外型肿瘤（14±8个月）（P〈0．01）;非小细胞肺癌PFS（11±5个月）明显长于小细胞肺癌（4±2个月）（P〈0．0001）;高、中分化癌PFS（15±8个月）明显长于低分化癌（7±3个月）（P〈0．0001）。结论联合经皮及经气管镜引导腔内冷冻消融治疗是中央型肺癌的一种有效、安全治疗方法,其术后PFS与肿瘤生长部位、病理类型及分化程度相关。

Treatment of central type lung cancer by combined percutaneous and endbronchial cryotherapy

Objective To investigate combined percutaneous and endbronchial cryotherapy therapy for the treatment of central type lung cancer （CTLC）. Methods Forty-seven patients with unrespectable CTLC can be divided into 3 parts, 22 cases of endotracheal tumors, 26 cases of tracheal wall tumors and 21 cases of extratracheal type tumors. Sixty nine times of combined percntaneous cryosurgery, endobronchial cryosurgery and airway stenting were carried out in these patients. The progression-free survivals （PFS） of enrolled patients were assessed and the influence of tumor location, pathologic type and differentiation to PFS were discussed later. Result Within 3 days after treatment, ventilatory capacity and performance status had obviously increased and cough, signs of dyspnea, hemoptysis and atelectasis improved significantly, but symptoms of pneumothorax and pleural effusion emerged. After 2 weeks, all complications had disappeared completely. PFS for endotracheal tumors （8 ±4 months） was shorter than that for tracheal wall （ 13 ±6 months, P 〈0.05） and extratracheal （ 14±8 months, P 〈0.01 ） tumors. The PFS of NSCLC （ 11±5 months） was significantly longer than that of SCLC （4± 2 months, P 〈 0. 0001 ）. PFS of medium or well differentiated CTLC （15 ± 8 months） was significantly longer than that of poorly differentiated CTLC （7 ± 3 months, P 〈 0.0001 ）. Conclusion In conclusion, combined cryotherapy is a safe and effective treatment for CTLC. PFS can be influenced by tumor location and pathologic type.