Percutaneous Cryoablation of Lung Tumors: Feasibility and Safety
Percutaneous Cryoablation of Lung Tumors: Feasibility and Safety
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DOI：
10.1016/j.jvir.2011.11.019
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发表时间：
2012-03-01
影响因子：
2.9
通讯作者：
Kuribayashi, Sachio
中科院分区：
文献类型：
--
作者：
Inoue, Masanori;Nakatsuka, Seishi;Kuribayashi, Sachio
目的：评价冷冻消融治疗肺肿瘤的安全性和可行性，以及并发症的发生率和危险因素。材料和方法：本研究包括117例396个肺肿瘤的193次冷冻消融治疗。进行单变量和多变量分析以评估常见并发症的危险因素。结果：冷冻消融后119次(61.7%)、136次(70.5%)和71次(36.8%)分别出现气胸、胸腔积液和咯血，各1次后出现膈神经麻痹、冻伤和脓胸(0.52%)。471个穿刺点中有1个(0.20%)可见近端肿瘤种植。在119次气胸治疗中，21次(17.6%)需要插入胸管，2次(1.7%)需要胸膜固定术。193次治疗中有15次出现延迟性和复发性气胸(7.8%)。较多的冷冻探头是气胸的显著预测因素(P=.001)。男性(P=.047)和无同侧手术史(P=.012)是需要插入胸管的预测因素，无同侧手术史(P=.021)是延迟/复发性气胸的预测因素。冷冻探头数目较多(P=.001)和无同侧手术史(P=.004)是胸腔积液的预测因素。较多的冷冻探头(P<；.001)和较小的年龄(P=.034)是咯血的预测因素。白细胞计数、血小板计数、血红蛋白水平和C反应蛋白水平的平均变化分别为2,418/亩L+/-2,260(P<；.001)，-2.0×10(4)/亩L+/-3.2(P<；.001)，-0.77 mg/dL+/-0.89(P<；.001)和3.0 mg/dL+/-2.9(P<；.001)。
Purpose: To evaluate the safety and feasibility of cryoablation for lung tumors as well as the incidence of, and risk factors for, complications.Materials and Methods: This study included 193 cryoablation sessions for 396 lung tumors in 117 consecutive patients. Univariate and multivariate analyses were performed to assess risk factors for common complications. Changes in laboratory values were analyzed the day after cryoablation.Results: Pneumothorax, pleural effusion, and hemoptysis occurred after 119 (61.7%), 136 (70.5%), and 71 (36.8%) sessions, respectively., Phrenic nerve palsy, frostbite, and empyema occurred after one session each (0.52%). Proximal tumor implantation was observed in one of 471 punctures (0.20%). Of 119 sessions with pneumothorax, 21 (17.6%) required chest tube insertion and two (1.7%) required pleurodesis. Delayed and recurrent pneumothorax occurred in 15 of 193 sessions each (7.8%). A greater number of cryoprobes was a significant (P = .001) predictor of pneumothorax. Male sex (P = .047) and no history of ipsilateral surgery (P = .012) were predictors for the need for chest tube insertion, and no history of ipsilateral surgery (P = .021) was a predictor for delayed/recurrent pneumothorax. Greater number of cryoprobes (P = .001) and no history of ipsilateral surgery (P = .004) were predictors for pleural effusion. Greater number of cryoprobes (P < .001) and younger age (P = .034) were predictors for hemoptysis. Mean changes in white blood cell count, platelet count, hemoglobin level, and C-reactive protein level were 2,418/mu L +/- 2,260 (P < .001), -2.0 x 10(4)/mu L +/- 3.2 (P < .001), -0.77 mg/dL +/- 0.89 (P < .001), and 3.0 mg/dL +/- 2.9 (P < .001), respectively.Conclusions: Percutaneous cryoablation could be performed minimally invasively with acceptable rates of complications.