CT引导下射频消融术作为多发肺结节手术替代方案的疗效与安全性OA
Efficacy and safety of CT-guided radiofrequency ablation as a surgical alternative for multiple pulmonary nodules
目的 评估 CT引导下经皮穿刺射频消融(radiofrequency ablation,RFA)术作为电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)的替代方案,治疗多发肺结节的疗效与安全性.方法 回顾性分析 2020年10月至 2022年 10月江苏省中医院收治的 113例多发肺结节患者的临床资料,根据治疗方式分为 RFA组(n=50)和VATS组(n=63).对比两组患者围手术期指标(手术时间、术中出血量、术后住院时间),肿瘤学结局(无复发生存期、总生存期)和术后并发症发生率.采用单因素和多因素 Cox回归分析评价预后的独立危险因素.结果 RFA组的手术时间显著短于 VATS组[(75.2±20.1)min vs(102.3±28.7)min,P＜0.001],两组术中出血量和术后住院时间差异无统计学意义.经过 24(12,30)个月的随访,两组无复发生存期(HR=1.25,P=0.445)和总生存期(HR=1.42,P=0.402)差异均无统计学意义.高实性成分混合磨玻璃结节及实性结节是多发肺结节患者无复发生存期(HR=2.44,P=0.023;HR=2.97,P=0.007)和总生存期(HR=2.87,P=0.022;HR=3.43,P=0.005)的独立危险因素.RFA组的总并发症发生率低于 VATS组(12.0%vs 34.9%,P=0.009).结论 CT引导下 RFA 治疗多发肺结节的疗效与 VATS相当,且安全性良好,有望作为多发肺结节外科手术的替代方案.
Objective To evaluate the efficacy and safety of CT-guided percutaneous radiofrequency ablation(RFA)as an alternative for video-assisted thoracoscopic surgery(VATS)in treating multiple pulmonary nodules.Methods A retrospective analysis was conducted on the clinical data of 113 patients with multiple pulmonary nodules admitted to Jiangsu Provincial Hospital of Traditional Chinese Medicine from October 2020 to October 2022.The patients were divided into the RFA group(n=50)and the VATS group(n=63)based on the treatment method.Perioperative indicators(operation time,intraoperative blood loss,postoperative length of hospital stay),oncological outcomes(recurrence-free survival[RFS],overall survival[OS]),and postoperative complication rates were compared between the two groups.Univariate and multivariate Cox regression analysis was performed to identify independent prognostic factors.Results The operation time in the RFA group was significantly shorter than that in the VATS group([75.2±20.1]min vs[102.3±28.7])min,P＜0.001).No statistically significant differences were observed in intraoperative blood loss and postoperative length of hospital stay.After follow-up of 24(12,30)months,no statistically significant differences were found in RFS(HR=1.25,P=0.445)or OS(HR=1.42,P=0.402)between the two groups.Mixed ground-glass nodules with high solid component and solid nodule were identified as independent risk factors for RFS(HR=2.44,P=0.023;HR=2.97,P=0.007)and OS(HR=2.87,P=0.022;HR=3.43,P=0.005)in patients with multiple pulmonary nodules.The total complication rate in the RFA group was lower than that in the VATS group(12.0%vs 34.9%,P=0.009).Conclusions The efficacy of CT-guided RFA in treating multiple pulmonary nodules is comparable to that of VATS,with good safety,and it shows promise as an alternative to surgical treatment for multiple pulmonary nodules.
马长辉;章斌;虞林湘;管仲;杨骏艺;镇海文
江苏省中医院心胸外科,南京 210029江苏省中医院心胸外科,南京 210029江苏省中医院心胸外科,南京 210029江苏省中医院心胸外科,南京 210029江苏省中医院心胸外科,南京 210029江苏省中医院心胸外科,南京 210029
医药卫生
多发肺结节射频消融电视辅助胸腔镜手术替代疗法微创治疗
multiple pulmonary nodulesradiofrequency ablationvideo-assisted thoracoscopic surgeryalternative therapyminimally invasive treatment
《中国临床医学》 2026 (2)
299-305,7
江苏省中医药科技发展计划项目(ZD202207).Supported by Traditional Chinese Medicine Science and Technology Development Plan Project of Jiangsu Province(ZD202207).
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