CAJ | 학술논문

目的：探讨螺旋CT导向下经皮穿刺采用多针双电极适形射频消融技术治疗肺部较大恶性肿瘤的可行性、安全性、临床疗效、并发症及处理。方法从2009年4月至2012年12月经穿刺活检术后病理诊断为肺癌的患者中，筛选病灶直径大于5cm ，Karnofsky评分≥70的患者24例随机分两组，于螺旋CT导向下行射频消融术治疗，每组各12例。 A组采用单针多位点叠合射频消融术，B组采用多针双电极适形射频消融技术。术前及术后CEA、CA-125、CA-199监测，记录所有患者术后及随访观察资料。对照比较两组症状缓解率、手术时间和并发症发生率，同时随访其治疗后中远期临床疗效，并作对比分析。结果两组技术成功率均为100％。术中A组消融病灶13枚，B组消融病灶14枚。 B组平均手术时间57．4min/台，A组平均手术时间76．3min/台。术后两组CEA、CA-125水平均有明显下降，无明显差异。 B组未发生严重并发症，A组并发症发生率16.7％。术后KPS评分B组优于A组（P＜0．01）。随访中远期临床疗效，A组完全缓解0例、部分缓解9例、无效0例，进展3例。 B组完全缓解1例、部分缓解10例、无效0例，进展1例。结论螺旋CT导向下多针双电极适形射频消融技术治疗肺部较大恶性肿瘤创伤小，主要并发症发生率减低，临床疗效明确，在扩大消融范围的同时，也根据肿瘤形态合理布针适形消融，对外科手术困难或不能耐受外科手术的较大肺癌尤其对合并肺慢性阻塞性疾病、瘤体靠近纵膈或胸膜下的治疗有显著优势，是一种新的微创治疗方法。
목적：탐토라선CT도향하경피천자채용다침쌍전겁괄형사빈소융기술치료폐부교대악성종류적가행성、안전성、림상료효、병발증급처리。방법종2009년4월지2012년12월경천자활검술후병리진단위폐암적환자중，사선병조직경대우5cm ，Karnofsky평분≥70적환자24례수궤분량조，우라선CT도향하행사빈소융술치료，매조각12례。 A조채용단침다위점첩합사빈소융술，B조채용다침쌍전겁괄형사빈소융기술。술전급술후CEA、CA-125、CA-199감측，기록소유환자술후급수방관찰자료。대조비교량조증상완해솔、수술시간화병발증발생솔，동시수방기치료후중원기림상료효，병작대비분석。결과량조기술성공솔균위100％。술중A조소융병조13매，B조소융병조14매。 B조평균수술시간57．4min/태，A조평균수술시간76．3min/태。술후량조CEA、CA-125수평균유명현하강，무명현차이。 B조미발생엄중병발증，A조병발증발생솔16.7％。술후KPS평분B조우우A조（P＜0．01）。수방중원기림상료효，A조완전완해0례、부분완해9례、무효0례，진전3례。 B조완전완해1례、부분완해10례、무효0례，진전1례。결론라선CT도향하다침쌍전겁괄형사빈소융기술치료폐부교대악성종류창상소，주요병발증발생솔감저，림상료효명학，재확대소융범위적동시，야근거종류형태합리포침괄형소융，대외과수술곤난혹불능내수외과수술적교대폐암우기대합병폐만성조새성질병、류체고근종격혹흉막하적치료유현저우세，시일충신적미창치료방법。
Objective To explore the feasibility ,safty,clinical efficacy and complications of spiral CT-guided comformal ablation by multi-pin bipolar radiofrequency system for treatment of larger lung neoplasmes . Methods 24 cases of lung cancer with the lesion size larger than 5 cm in diameter and karnofsky score above 70 were selected from April 2009 to December 2012 and its pathological diagnosis were confirmed by percutaneous needle biopsy The cases were divided randomly into two groupsand were treated by Spiral CT-guided pecutane-ous radiofrequency ablation ( PRFA) .The patients in group A underwent a StarBurst-XL needle PRFA and The patients in group B were treated by multi-pin bipolar PRFA.CEA,CA-125 and CA-199 levels of patients were measured before and after the operation ,and the data of postoperative following-up were recorded .The sympton relief rate,operation time,complication rate and medium-long-term curative effect through following-up between the two groups were analyzed comparatively .Results The technical success rate of both groups were 100%.13 lesions in group A and 14 lesions in group B were ablated after PRFA .The average operating time of in group A was 76.35 min,while 57.43 min in group B.The postoperative levels of CEA and CA-125 were declined ob-viously in both groups and there had no significant difference .The incidence of complications was lower and the postoperative kps score was higher in group B than those of group A ( P<0 .01 ) .Clinical efficacy of following-up data showed that there were 1 complete remission ,1 progression disease and 10 partial remission oftumor in group B,as no case complete remission,9 partial remission in group A.Conclusion Spiral CT-guided com-formal ablation by multi-pin bipolar radionfrequency system is a new option with minimal invasion and trauma , low postoperative incidence of complications and affirmative clinical efficacy for the treatment of larger lung neo -plasms.