摘要
目的探讨肺癌氩氦刀冷冻治疗的方法,并评估其临床疗效。方法收集2006年1月-2008年1月内经病理证实的肺癌患者68例,分别于术前1周和术后1个月行常规CT平扫和增强检查,测量肿瘤病灶最大直径和CT值,并比较冷冻治疗前后的变化。其中30例患者自愿接受CT灌注成像扫描,测量灌注参数并比较术前、术后灌注参数变化。应用Log-rank法计算所有患者的中位生存期并绘制生存期曲线图。结果所有患者肿瘤最大直径的平均值由(5.61±3.13)mm缩小至(5.15±3.00)mm,依据实体瘤评价标准(RECIST)好转率10.29%,总有效率98.52%。肿瘤直径最大层面病灶CT平均值平扫由术前(42.01±7.66)Hu减少至术后(25.61±2.06)Hu,增强由(66.99±7.65)Hu减少至(29.66±2.06)Hu,CT值明显降低。30例接受CT灌注成像检查患者的灌注参数改变分别为血流量(BF)由术前(48.32±8.41)ml·100ml-1·min-1减少至(28.73±8.92)ml·100ml-1·min-1,血容量(BV)由(65.38±10.49)ml/1000ml减少至(37.8±10.71)ml/1000ml,达峰时间(timetopeak,TTP)由(13.08±3.41)s减少至(10.01±3.38)s,渗透性(permeability,P)由(91.79±22.80)ml·100ml-1·min-1减少至(44.62±34.26)ml·100ml-1·min-1。以上所有结果的差异均有统计学意义(P<0.05)。68例患者随访至2009年4月30日的中位生存期为13个月。结论氩氦刀冷冻是治疗肺癌安全有效的方法。CT灌注成像能在早期反映氩氦刀冷冻治疗的疗效,配合常规的检查和评价方法,可以在术后及时发现肿瘤复发和残留的病灶,对肿瘤的进一步治疗有十分重要的指导意义。
Objective To investigate the technique of argon-helium cryoablation and to assess its efficacy in the treatment of lung cancer. Methods Sixty-eight patients with pathologically-proved lung cancer, who were admitted to the hospital between Jan 2006 and Jan 2008, were enrolled in the study. Both plain and enhanced CT scans were carried out one week before as well as one month after the cryoablation therapy. The maximum diameter and the average CT value of the tumor at the same cross section were measured and the results were compared. Thirty patients voluntarily took the CT peffusion examination, and the parameters were recorded and compared. The median survival time was calculated using Log-rank method. Results The mean maximum diameter decreased from （5.61 ± 3.13）mm before eryoablation to （5.15 ± 3.00）ram after the operation. According to RECIST criteria, the improvement rate was 10.29% and the total efficacy rate was 98.52%. The average CT value at the section with maximum diameter was reduced from （42.01 ± 7.66） Hu before the procedure to （25.61 ± 2.06）Hu after the procedure on plain CT scan, while the value was reduced from （66.99 ± 7.65）Hu to （29.66 ± 2.06）Hu on enhanced CT scan. The changes of CT peffusion parameters in 30 patients were as follows. （1） The blood flow dropped from （48.32 ± 8.41 ） ml/ 100 ml·min before cryoablation to （28.73 ± 8.92）ml/100 ml·min after the operation. （2） The blood volume was reduced from （65.38 ± 10.49） ml/1 000 ml to （37.8 ± 10,71）ml/1 000 ml. （3） The time-to-peak was decrease from （13.08 ± 3.41 ） s to （10.01±3.38） s. （4） The permeability was decreased from （91.79 ± 22.80） ml· 100 ml^-1·min^-1 to （44.62 ± 34.26）ml· 100 ml^-1·min^-1. The differences between all the above results before and after the eryoablation treatment were of statistical significance. The median survival time of 68 patients was 13 months. Conclusion Argon-helium cryoablation is a safe and effective treatment for lung cancer. CT perfusion imaging can help to make an early assessment of the therapeutic efficacy, and residual tumor as well as tumor recurrence can be promptly detected when a combination of CT perfusion imaging with other conventional examinations is employed, which is very important in guiding the clinical treatment.
出处
《介入放射学杂志》
CSCD
北大核心
2009年第7期510-514,共5页
Journal of Interventional Radiology
关键词
冷冻消融
肺癌
疗效评估
cryoablation
lung cancer
therapeutic evaluation
