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经皮穿刺射频消融治疗肺肿瘤 广州医学院广州呼吸疾病研究所胸外科 殷伟强 前言 n肺部恶性肿瘤的传统治疗方法: 手术 化疗 放疗 n许多患者不能接受手术治疗: 晚期肿瘤,或身体、年龄等因素。 n消融是近年来较为热门的针对上述患者的 治疗的方法之一 原理 n消融仪输出脉冲电波经 多极针传到肿瘤组织, 在细胞内经过能量转化 为热能,局部温度升高 ,起到热疗作用。治疗 后肿瘤组织变性坏死。 国产设备 n消融仪: 为尔福电子公司WE7568巨能消融仪,用多极 针经皮穿刺到肺内肿瘤 n消融设置: 治疗时间:每次1015分钟, 治疗温度:早期为7590,调整为95左 右 消融治疗的流程 操作方法 nCT检查后明确肿块大小及空间关系 n选择最靠近肿块皮肤、量度进针角度及深度。 n局麻后,用多极针分层穿刺到肺肿瘤内,释放多极 针进行消融治疗,每次10分钟 n根据肿瘤大小,形状调整针位置再进行治疗。 n关键在于CT准确定位,包括层面,角度 ,穿刺深度,应有明确数据。患者根据进 针位置可采用仰卧、侧卧或俯卧位。肩胛 骨、锁骨上、第一肋间、胸骨旁一般情况 下不宜作穿刺,以免损伤胸内血管、神经 等。 n靠近肺门、膈肌、胸膜顶肿瘤,穿刺时进 针不宜过深,治疗之释放子针也不要求到 肿瘤边缘,或选择较小型号多极针,完全 释放子针直径3cm,仍可起到较好治疗作 用。 病例1: 病例3: n射频消融与恶性肿瘤治疗效果与肿瘤大小 有关,与病理分类无关。 n送检病理组织中,可见肿瘤组织坏死,大量中性 白细胞渗出,附近正常组织充血水肿。 n射频消融术后出现并发症,可在术前术后相应处理: 术前口服可待因,减轻胸膜或支气管刺激引起的咳嗽; 肌注度冷丁或双氯灭痛,减轻术中术后疼痛 静注地塞米松,减轻消融治疗后水肿炎症反应 大量气胸可予胸腔闭式引流,量少及皮下气肿可不予处 理 重复使用多极针时应注意检查保护层以避免皮肤烧灼伤 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