目的 通过CT引导下行同轴穿刺活检联合微波消融(MWA)治疗肺部肿瘤的效果,探讨其技术特点、安全性、疗效及临床应用价值.方法 收集2014年8月至2016年6月上海瑞金医院放射介入科收治的肺部肿瘤患者20例,共23个肿瘤接受CT引导下同轴穿刺活检联合MWA治疗(其中肺部原发性肿瘤9例,转移瘤11例),根据肿瘤大小和形状,设置相应的消融功率和时间.术后随访4～26个月,通过定期复查胸部增强CT以观察其治疗效果.结果 行同轴穿刺活检病灶23个,肿瘤直径为0.80～2.40 cm,平均1.39 cm,行MWA病灶共23个,消融后即刻CT表现为病灶密度减低,穿刺活检阳性率为83.3％.20例患者完全缓解15例,部分缓解2例,无变化1例,进展2例,治疗有效率85％.术后1例发生气胸,1例发生血气胸,1例出现急性渗出性胸膜炎,2例发热,无一例发生针道转移,无一例因MWA治疗导致死亡.随访至2016年10月,17例患者存活,3例转移性肺癌患者均死于原发肿瘤进展(分别为肠癌、食管癌及肝癌).1年局部控制率为65％,中位无进展生存时间为15.5个月(95％C/16.6～23.4),1、2年生存率分别为90％、85％.结论 通过CT引导对肺部肿瘤行同轴穿刺活检联合MWA具有创伤小、活检阳性率高、安全性高、疗效好等特点,可以提高患者的生活质量并延长生存时间,是目前应用前景较好的介入治疗方式之一.%Objective To evaluate the effect of CT-guided percutaneous coaxial needle biopsy combined with microwave ablation (MWA) for the treatment of lung tumors, and to discuss its technique, safety, curative effect and clinical application value. Methods A total of 20 patients with lung tumor, who were admitted to the Department of Interventional Radiology, Shanghai Ruijin Hospital, China, during the period from August 2014 to June 2016, were collected. Among the 20 patients, primary pulmonary cancer was diagnosed in 9 and metastatic tumor in 11. A total of 23 tumor lesions were detected, and CT-guided percutaneous coaxial needle biopsy combined with MWA was performed for all lesions. Based on the size and shape of the tumor, the corresponding ablation power and time of duration were set up. After the treatment, the patients were followed up for 4-26 months, and chest enhanced CT examination was regularly reexamined to assess the curative effect. Results Percutaneous coaxial needle biopsy was carried out for 23 lesions, the tumor diameters ranged from 0.80 cm to 2.40 cm, with a mean of 1.39 cm. MWA was employed for 23 lesions. CT scan performed immediately after MWA showed that the density of tumor lesion became decreased, the diagnostic positive rate of needle biopsy was 83.3％. After the treatment, complete remission was obtained in 15 patients, partial remission in 2 patients, stable disease in one patient, and progression.
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