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目的探讨超声和CT引导下氩氦刀冷冻治疗恶性肿瘤的临床应用价值。方法无法手术切除或不愿手术切除的恶性肿瘤患者45例49个病灶,在超声或CT引导下进行氩氦刀冷冻治疗,肿瘤分为≤3cm和>3cm两组,观察术中冰球形成和冰球覆盖病灶率、术后病理变化和病灶缩小率。结果87.5%的冰球在冷冻开始后50s内形成,声像图表现为横断面上靶区内的弧形强光带后方伴声影,纵断面上靶区内“成角凸起”的强光带后伴声影。随着复温,强光带消失,冷冻区呈不均匀高回声;CT扫描,冷冻消融区为类圆形的低密度区。治疗后组织病理学可见细胞浆疏松、空泡样改变、细胞核固缩、核浓染、核碎裂及溶解。两组术中冰球覆盖率≥80%、<80%者分别为72.7%、27.3%和26.3%、73.7%,两组冰球覆盖率差别有显著性意义(P<0.05)。术后3个月,≤3cm和>3cm两组中,病灶缩小率≥50%的分别占81.8%和28.9%,两组病灶缩小率差别有极显著性意义(P<0.01)。结论超声和CT引导下氩氦刀冷冻治疗恶性肿瘤,定位准确,影像学改变明显、疗效确切、安全可靠,特别对小病灶效果显著。
Objective To investigate the clinical value of cryosurgery assisted by ultrasound and CT guided cryoablation in treating malignant tumors. Methods 45 patients with malignant tumors who could not be surgically removed or who were not willing to be surgically resected were treated with argon-helium cryoablation under the guidance of ultrasound or CT. The tumors were divided into two groups of ≤3cm and> 3cm, and the formation of ice hockey Cover the lesion rate, postoperative pathological changes and lesion reduction rate. Results 87.5% of ice hockey formed within 50 seconds after the start of freezing. The sound image showed the back of sound arc with arc in the target area of cross section. The “angled bulge” glare in the vertical section With sound after the film. With the rewarming, the disappearance of the bright band, the frozen area was uneven high echo; CT scan, frozen ablation zone as a circular low density area. Histopathology after treatment showed loose cytoplasm, vacuolar changes, nuclear condensation, nuclear staining, nuclear fragmentation and dissolution. The coverage rate of hockey puck in both groups was ≥80% and <80% were respectively 72.7%, 27.3% and 26.3%, 73.7%. There was significant difference between two groups (P <0.05). At 3 months after operation, in both groups ≤3cm and> 3cm, the reduction rates of lesions ≥50% accounted for 81.8% and 28.9% respectively. There was significant difference between the two groups in the rate of lesion reduction (P <0.01). Conclusion Ultrasound and CT-guided cryoablation of cryoablation of malignant tumors, accurate positioning, significant changes in imaging, effective, safe and reliable, especially for small lesions significant effect.