CT引导下射频消融治疗肺癌的学习曲线

目的探讨CT引导下射频消融治疗不能手术原发性肺癌的学习曲线。方法收集2007年3月～2009年6月90例不能手术的肺癌患者临床资料和CT引导下射频消融治疗结果,所有患者由射频消融研究组完成,按照时间顺序分为3组(A、B和C组,每组30例)。A组在14个月内完成,平均每月2.1例;B组在7个月内完成,平均每月4.3例;C组在6个月内完成,平均每月5.0例。3组性别、年龄、体力状况(ECOG)评分、病灶大小、消融灶数量、位置等无统计学差异(P>0.05)。比较3组的操作时间、射频消融时间、病灶定位时间、并发症发生率、术后住院时间和完全消融率等。结果 C组操作时间(42.0±13.3)min明显短于A组(53.7±16.7)min和B组(60.5±26.5)min(F=6.821,P=0.002,PA-B=0.182,PA-C=0.024,PB-C=0.000);C组的射频针在肿瘤内的定位时间(5.5±1.3)min明显短于A组(13.2±4.0)min和B组(11.4±5.7)min(F=28.867,P=0.000,PA-B=0.095,PA-C=0.000,PB-C=0.000);术后住院时间B组(2.5±0.8)d和C组(2.4±1.6)d明显短于A组(3.2±0.8)d(F=4.646,P=0.012,PA-B=0.024,PA-C=0.005,PB-C=0.566)。3组间肿瘤完全消融率和并发症无统计学差异(P>0.05)。结论 CT射频消融治疗不能手术肺癌存在学习曲线的问题,经过60例的经验积累,会缩短射频消融的操作时间和住院时间。

Learning Curve of CT-guided Percutaneous Radiofrequency Ablation in the Treatment of Lung Cancer

Objective To evaluate the learning curve of CT-guided percutaneous radiofrequency ablation(RFA) for inoperable lung cancer.Methods The clinical data and treatment outcomes of 90 patients undergoing percutaneous RFA procedures for inoperable primary lung cancer were collected prospectively between March 2007 and June 2009.All the patients were managed by a single team of surgeons.The patients were divided into 3 groups(groups A,B and C with 30 in each) according to the date of the operation.In group A,the 30 cases of RFA was completed within 14 months(2.1 cases per month on average),while that was 7 months in group B(4.3 cases per months),and 6 months in group C(5.0 cases per months).There were no significant differences among the groups with respect to sex,age,ECOG score,pathologic type,tumor size and tumor location(P>0.05).The time for the procedure and radiofrequency ablation,and tumor puncture,morbidity,hospital stay,and complete ablative rate were retrospective compared among the three groups.Results The time for the procedure in group C was(42.0±13.3) min,which was significantly shorter than that in groups A and B (53.7±16.7) min and(60.5±26.5) min;F=6.821,P=0.002,PA-B=0.182,PA-C=0.024,PB-C=0.000];the time of tumor puncture in group C was(5.5±1.3) min,which was also significantly shorter than that in groups A and B (13.2±4.0) min and(11.4±5.7) min;F=28.867,P=0.000,PA-B=0.095,PA-C=0.000,PB-C=0.000].The hospital stay in groups B and C was(2.5±0.8) and(2.4±1.6) days respectively,both were significantly shorter than that in group A (3.2±0.8) d;F=4.646,P=0.012,PA-B=0.024,PA-C=0.005,PB-C=0.566].No significant difference in complete ablative rate and overall morbidity was observed among the three groups.Conclusions There is a significant learning curve in RFA for inoperable lung cancer.Shorter hospital stay and operation time can be achieved with the accumulated experience after the first 60 cases by a specialized team.