氩氦刀冷冻消融治疗肺原发或转移性恶性肿瘤的临床疗效观察

发布时间：2018-05-04 07:20

本文选题：肺部恶性肿瘤 + 疗效　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:对51例接受CT引导下经皮氩氦刀冷冻消融治疗的肺原发或转移性恶性肿瘤患者进行疗效评价,包括瘤灶大小变化、临床症状、体能状态、并发症等方面,探讨氩氦刀冷冻消融技术治疗肺部恶性肿瘤的有效性及安全性。方法:采用回顾性的研究方法收集2013年11月-2016年12月期间在中日友好医院中西医结合肿瘤内科接受CT引导下经皮氩氦刀冷冻消融治疗的51例肺部恶性肿瘤患者的临床资料,分析氩氦刀冷冻消融治疗前后患者的症状、体能状态和影像学结果改变,统计术中术后不良反应及相关中医药治疗方法,并追踪冷冻术后患者的生存期和生存率情况。结果:1.实体瘤疗效评定:51例肺部肿瘤病灶,直径最大为90.07mmm,最小为13.03mm。将患者氩氦刀治疗前的影像结果与距离2017年4月前最近的一次复查的影像结果相比较,其中复查时间最长1366天,最短21天。根据RECIST1.1实体瘤疗效评价标准进行评价,客观有效率(CR+PR)15.69%,疾病控制率(CR+PR+SD)84.31%。2.体能状态评价:根据Karnofsky功能状态评分标准,观察患者治疗前后的功能状态改变情况。治疗后1周功能状况改善的13例(25.49%),较术前无明显变化的33例(64.71%),体能状况变差的5例(9.80%)。提高+稳定率为90.2%。3.临床症状变化:取肺癌八个常见症状,结合患者病情,观察治疗后1周患者相应症状的改变程度。咳嗽缓解7例(36.84%),咳痰缓解6例(50.0%),咯血或痰中带血缓解3例(30.0%),胸痛缓解11例(84.60%),乏力缓解27例(56.25%),气短缓解29例(63.04%),胸闷憋气缓解5例(26.32%),食欲不振缓解 4 例(14.29%)。4.并发症:51例患者均顺利完成手术,出现氩氦刀冷冻消融治疗相关并发症者37例,总体并发症发生率为72.55%。其中,气胸9例,发热6例,咳嗽4例,咳血6例,畏寒怕冷2例,食欲不振3例,术后疼痛5例,血胸1例,出血所致窒息1例,无手术相关死亡发生。术后辅以中草药汤剂治疗,以"益气健脾、清肺散结"为治则,辨证加减用药。所有患者在2周内病情好转。结论:1.氩氦刀冷冻消融治疗肺原发或转移性恶性肿瘤疗效确切,可快速减轻肿瘤负荷,延缓肿瘤进展,改善患者不适症状,提高生活质量。2.氩氦刀冷冻消融治疗适应证广,创伤小,患者耐受度好,并发症轻微,术后恢复快。与放化疗或中医药等手段联合应用,安全有效,值得进一步研究并在临床上推广。
[Abstract]:Objective: to evaluate the curative effect of 51 patients with primary or metastatic lung cancer treated by CT guided cryoablation with argon and helium knife, including the changes of tumor focus, clinical symptoms, physical condition, complications and so on. To evaluate the efficacy and safety of argon-helium ablation technique in the treatment of pulmonary malignant tumors. Methods: from November 2013 to December 2016, 51 patients with pulmonary malignant tumors who were treated with CT-guided cryoablation with argon and helium knife were collected retrospectively from November 2013 to December 2016 in the Department of Oncology of Integrated Chinese and Western Medicine in Sino-Japanese Friendship Hospital. The symptoms, physical condition and imaging results of patients before and after cryoablation with argon-helium knife were analyzed. The adverse reactions during and after cryopreservation were analyzed. The survival time and survival rate of patients after cryopreservation were followed up. The result is 1: 1. The curative effect of solid tumor was evaluated in 51 cases of pulmonary tumor. The maximum diameter was 90.07 mm and the smallest was 13.03 mm. The imaging results of the patients before Argon-helium knife treatment were compared with those of the most recent reexamination before April 2017. The longest time of reexamination was 1366 days and the shortest was 21 days. According to the evaluation criteria of RECIST1.1 solid tumor curative effect, the objective effective rate was 15.69%, and the disease control rate was 84.31%. 2. Physical state evaluation: according to Karnofsky functional state score, the changes of patients' functional state before and after treatment were observed. One week after treatment, 13 patients with improved functional status were 25.49m, compared with 33 patients who had no obvious change before treatment, and 5 patients with poor physical fitness. The stability rate was increased to 90.20.3. Changes of clinical symptoms: eight common symptoms of lung cancer were taken and combined with patients' condition to observe the degree of change of corresponding symptoms 1 week after treatment. There were 7 cases of cough relief, 6 cases of expectoration relief, 3 cases of hemoptysis or sputum with blood relief, 3 cases of hemoptysis and sputum with blood relief, 11 cases of relief of chest pain, 11 cases of relief of chest pain, 56.25 cases of relief of asthenia, 29 cases of relief of shortness of breath, 5 cases of relief of shortness of breath, 4 cases of anorexia and 4 cases of anorexia. All 51 cases of complications were successfully completed, 37 cases had complications associated with cryoablation of argon and helium knife, the overall incidence of complications was 72.55%. There were 9 cases of pneumothorax, 6 cases of fever, 4 cases of cough, 6 cases of hemoptysis, 2 cases of chills and chills, 3 cases of anorexia, 5 cases of postoperative pain, 1 case of hemothorax and 1 case of asphyxia caused by hemorrhage. After operation with Chinese herbal medicine decoction treatment, "invigorating qi and spleen, clearing the lung and dispersing knot" as the treatment principle, differentiation of symptoms and signs plus or minus medication. All patients improved within 2 weeks. Conclusion 1. Argon-helium ablation is effective in the treatment of primary or metastatic lung neoplasms. It can reduce tumor load, delay tumor progression, improve uncomfortable symptoms and improve quality of life (QOL). Argon-helium cryoablation has the advantages of wide indication, small trauma, good tolerance, slight complications and quick recovery. Combined with radiotherapy and chemotherapy or traditional Chinese medicine, it is safe and effective, and worth further study and clinical promotion.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

【参考文献】