摘要
背景与目的:外科手术切除、放疗和化疗是治疗肺恶性肿瘤的主要方法,但对失去手术机会、肺内多发转移或放化疗失败的患者,积极探索新的治疗方法成为亟待解决的问题。近年来,射频消融作为肺恶性肿瘤新的治疗方法,受到广泛关注。本研究旨在观察CT引导下CelonLab射频仪治疗兔肺内VX2肿瘤的影像学表现、病理演变,评价治疗效果,进一步探索肺恶性肿瘤的射频治疗参数。方法:采用同轴套管针经皮穿刺的新方法建立兔VX2肺肿瘤模型。实验组27只予以射频治疗,对照组9只予以假性治疗。两组均于设定时间点行CT扫描,观察影像学表现。实验组18只于治疗后不同时间点随机处死,观察病理演变;其余9只待其自然死亡,评估疗效、计算生存期。对照组9只均待其自然死亡,计算生存期。结果:射频后即刻CT扫描见病灶周围磨玻璃影可伴内部空洞或小空泡。与病理HE染色切片对照发现,术后随访中CT增强扫描无强化不能完全除外肿瘤细胞残留。术后24 h大体解剖见病灶由中心向外周形成4条沿能量梯度分布的反应带:中央炭化或蒸发中心(电极穿刺针道),灰白色凝固性坏死带,棕红色出血带,粉红色充血渗出带。术后肿瘤病灶周围出现不同程度炎性反应,4周后基本吸收,最终残留厚壁纤维组织层包绕中央凝固性坏死及少量陈旧性出血。实验组待其自然死亡的9只中,完全缓解率78%。实验组与对照组生存时间分别为(38.0±5.9)d与(24.0±3.1)d,差异有统计学意义(t=2.634,P=0.018)。射频能量与病灶直径之间存在直线回归关系,回归系数的检验P=0.000,直线回归方程为Y^=-2.3372+1.4361X。结论:采用同轴套管针经皮穿刺法建立兔VX2肺肿瘤模型安全、迅速,短期内成瘤率高。射频消融治疗肺内肿瘤疗效确切,安全、微创,并发症少。术后射频区域有一个发展演变的过程,疗效评估可以术后1个月为新基线。射频能量与病灶直径之间存在直线回归关系。
Background and purpose： Surgical resection, radiotherapy and chemotherapy are main remedies for malignant lung tumors. However, to explore new therapies for patients ineligible for surgery, multiple metastases in lung and progressive with radiotherapy or chemotherapy is an urgent problem. Recently, radiofrequency ablation has attracted a wide spread attention as a new treatment for malignant lung tumors. In this study, we investigated CT-guided radiofrequency ablation of VX2 lung tumor in rabbits, with the aim to observe CT images and pathologic regression, to evaluate efficacy and to explore treatment parameters of RFA. Methods： Build the model of VX2 lung tumors in rabbits with a new method of CT-guided percutaneous puncture by coaxial trocar. The experimental group included 27 rabbits with RFA treatment, while the control group had 9 rabbits with false treatment. Two groups were performed CT scans at diflbrent time points to observe CT images. For the experimental group, 18 were killed at different time points to observe pathologic regression; while the rest was kept natural death, evaluating efficacy and calculated survival time. The control group had natural death and the survival time was calculated. Results： CT images taken immediately after RFA showed the lung tumor surrounded by ground-glass opacity （GGO）, sometimes, with a cavity or smallvacuoles in the lesion. It couldn＇t exclude the residual of tumor cells even without enhancement of CT scan according to pathological finding in the follow-up. Twenty-four hours after operation, in gross anatomy, the area of RFA showed four zones from inside to outside along power gradient： the carbonization or evaporation center, gray coagulation necrosis zone, red-brown hemorrhage zone and pink hyperemic exudate zone. There was some degree of inflammation pathologically around the lesion after operation, which was absorbed within four weeks mainly; eventually, left thick- walled fibrous tissue encysting coagulation necrosis and slightly remote hemorrhage. The rate of complete response of the experimental group was 78%. The survival time of the experimental group and the control group had significant difference （t=2.634, P=0.018）, which was 38.0±5.9 d and 24.0±3.1 d, respectively. The linear regression equation between RF energy and the lesion size was Y^=-2.3372＋I.4361X, with test of regression coefficient （P=0.000）. Conclusion： The method of CT-guided percutaneous puncture by coaxial trocar to build the model of VX2 lung tumors in rabbits was safe and rapid, with high tumor formation rate. Our study showed not only safety, micro-invasion and low rate of complications but also definite efficacy of RFA for lung tumors. To evaluate efficacy, 1 month after operation could be the new baseline due to the development and succession of the RFA area. There was relationship of linear regression between RF energy and the lesion size.
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2013年第5期347-352,共6页
China Oncology
基金
上海市科委基金项目(No:11nm0504000)
关键词
VX2
肺肿瘤
CT
射频消融
病理转归
VX2
Lung tumor
Computer tomography （CT）
Radiofrequency ablation （RFA）
Pathologic regression
