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目的研究 CT 导向经皮肺穿刺氩氦刀靶向治疗肺部肿瘤前后的影像表现及临床疗效评价。方法对96例肺部肿瘤患者采用 CT 引导下经皮肺穿刺氩氦刀靶向治疗。所有患者术前、术后均行 CT 扫描,测定肿瘤大小及 CT 值,并分别于术后1、3、6、12个月复查 CT。结果原发肺癌82例,肺转移瘤14例,共110个病灶,单病灶89例,多病灶7例。氩氦刀共治疗103次,平均每次治疗1.07个病灶。每次最多治疗3个病灶。肿瘤直径1.2～15.0 cm,平均(4.0±2.5)cm。其中瘤灶直径<2 cm 12个,≥12～4 cm 51个,≥4～6 cm 24个,>6 cm 23个。冰球彻底覆盖瘤灶达其边缘外1 cm 者25例。肿块直径<4 cm 的63个,有效率为100%,≥4～6 cm 的有效率为95.8%(23/24),>6 cm 的有效率为69.6%(16/23)。肺部肿瘤冷冻后 CT 可见逐渐增大的低密度类圆形冷冻区,与非冷冻区有明显的界限。冷冻区中心 CT 值为负值,术后即刻 CT 值平均下降30～50 HU,与术前 CT 值相比差异有统计学意义(Jp<0.01)。氩氦刀冷冻治疗前后肿瘤直径比较,差异有统计学意义(p<0.05)。直径<2 cm 的病灶治疗3个月后均已消失。术后12个月 CT 复查81个被消融肿块,完全消失16个(19.7%),缩小42个(51.9%),稳定17个(21.0%),增大6个(7.4%),总有效率为92.6%。43个鳞癌和28个腺癌经氩氦刀治疗12个月后疗效差异无统计学意义(χ~2=0.05,p>0.05)。结论肺部肿瘤氩氦刀冷冻治疗后 CT 影像表现对其疗效的评价有重要参考价值。
Objective To study the imaging manifestations and clinical evaluation of CT-guided percutaneous pulmonary puncture and cryoablation for the treatment of lung tumors. Methods 96 cases of lung cancer patients under the guidance of CT-guided percutaneous puncture of argon-helium knife targeted therapy. All patients underwent CT scan before and after surgery to determine tumor size and CT value. CT was performed at 1, 3, 6 and 12 months after operation. Results There were 82 cases of primary lung cancer, 14 cases of lung metastases, a total of 110 lesions, 89 single lesions and 7 multiple lesions. Argon-helium knife were treated 103 times, an average of 1.07 lesions per treatment. Each treatment up to 3 lesions. Tumor diameter 1.2 ~ 15.0 cm, with an average (4.0 ± 2.5) cm. There were 12 lesions with tumor diameter <2 cm, 51 lesions ≥ 12 ~ 4 cm, 24 lesions ≥ 4 ~ 6 cm and 23 lesions> 6 cm. Hockey pundit completely cover the edge of the tumor up to 25 cm. Sixty-three of 63 cm <4 cm in diameter had an effective rate of 100%, an effective rate of 95.8% (23/24) for ≥ 4-6 cm, and 69.6% (16/23) for> 6 cm. After the CT scan of frozen lung tumor, a gradually increasing low density circular freezing zone can be seen, which has a clear boundary with the non-freezing zone. The value of CT in the frozen area was negative. The CT value decreased 30 ~ 50 HU on average after operation, which was significantly different from preoperative CT value (Jp <0.01). The tumor diameters before and after cryoablation were significantly different (p <0.05). Lesions <2 cm in diameter have disappeared after 3 months of treatment. Twelve months after the operation, 81 ablated masses were completely disappeared, 16 disappeared completely (19.7%), 42 (51.9%) contracted, 17 (21.0%) stable and 6 (7.4% 92.6%. There was no significant difference in curative effect between 43 squamous cell carcinomas and 28 adenocarcinomas after treated with argon-helium knife for 12 months (χ ~ 2 = 0.05, p> 0.05). Conclusion CT imaging of cryosurgical treatment of lung tumor with cryoablation has an important reference value for the evaluation of its curative effect.