CT引导下无水乙醇消融治疗侵犯胸膜或胸壁的恶性肿瘤

目的 探讨CT引导下无水乙醇消融(PEA)治疗侵犯胸膜或胸壁恶性肿瘤的可行性及其临床疗效.方法 9例侵犯胸膜或胸壁的恶性肿瘤患者,均采用CT引导下经皮穿刺无水乙醇消融治疗,观察其生活质量改善情况及应用CT扫描评价其治疗效果.结果 PEA治疗成功后所有患者癌性疼痛得到缓解,疼痛评分减低到0～3分,患者的咳嗽、咯血症状消失,食欲、睡眠明显改善,体重增加.KPS评分达90分以上.患者术中及术后无严重不良反应和并发症.全组9例患者首程治疗18个病灶,经34次PEA治疗后获得消融成功.1例转移性胸膜间皮瘤患者和1例肝癌胸膜转移瘤患者在PEA成功后随访中出现病灶局部复发和新发病灶,继续PEA治疗取得良好疗效.1例肺癌患者于PEA治疗成功后第8个月肿瘤复发,再行2次PEA治疗后肿瘤得到控制,另1例肺癌患者PEA成功后第6个月肿瘤复发但放弃治疗.全组中位随访11个月(6～24个月).2例原发肝癌患者于治疗后第8个月和第9个月死于脑转移,其余病人仍在随访之中.结论 CT引导下无水乙醇消融治疗侵犯胸膜或胸壁的恶性肿瘤应用方便、对患者的创伤小,临床疗效确切,并发症少,不良反应轻,可明显改善癌症患者的生活质量.因此,对无手术适应证以及术后、放化疗后有残留、复发的侵犯胸膜或胸壁的恶性肿瘤患者,PEA治疗是一种很好的治疗选择.

CT-guided percutaneous ethanol ablation in the treatment of malignancies with pleural or chest wall invasion

Objective To explore the feasibility and efficiency of CT-guided percutaneous ethanol ablation (PEA) in the treatment of malignant tumors with pleura] or chest wall invasion.Methods Nine patients of malignant tumors with pleura] or chest wall invasion that failed to respond to operation, radiotherapy, or chemotherapy were treated by PEA under CT guidance.The improvement of quality of life (QOL) during the treatment was observed and the efficiency was evaluated by CT scan.Follow-up was conducted for 6 - 24 months.Results After successful ethanol ablation, cancer pain of the patients was relieved obviously and pain degree reduced to 0 -3 score according to the numerical rating scale (NRS).Cough and hemoptysis disappeared.Appetite and sleeping were improved markedly.Body weight increased and the Karnofsky performance status (KPS) score was over 90.No serious adverse effect and complication occurred during and after PEA.PEA was performed successfully 34 times in 18 lesions of these 9 patients.In follow-up, local recurrence and new tumors appeared in 2 patients, but good results were achieved after the second PEA treatment.One tumor came to recurrence in a patient of lung cancer, but it was well controlled after another two times of PEA treatment.One patient with lung cancer gave up treatment and came to recurrence after successful PEA treatment 7 months later.Two patients of primarily hepatocellular carcinoma died of brain metastases 8 and the 9 months after treatment.Condusion With little damage and few complications, CT-guided PEA is convenient and effective in treatment of malignant tumors with pleural invasion.