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目的回顾性地确认肺肿瘤病人经皮射频消融(RFA)和微波消融(MWA)后肋骨骨折的发生率及可能的危险因素,并确认与肋骨骨折有关的并发症。材料与方法机构审查委员会批准获得了HIPAA依从性的回顾性研究。以2004年2月—2010年4月期间接受RFA和(或)MWA治疗的195个肺肿瘤的163例病人为研究对象。由取得委员会认证资格的放射医师用至少3个月一次的随访CT影像做回顾性分析,来确定是否存在肋骨骨折。用广义上的估计方程来评估病人的人口统计资料、肿瘤特点、治疗参数、消融区特点等对肋骨骨折发展的影响。用Kaplan-Meier曲线评估病人消融后肋骨骨折概率的时间函数。对确定骨折的病人评估其临床参数(即肋骨或胸部的疼痛,肋骨骨折引起的脏器损害)。结果 13.5%(22/163例)的病人发现消融区邻近肋骨骨折。肋骨骨折的估计概率1年为9%、3年为22%。消融治疗后女性病人比男性病人更容易发生骨折(P=0.041)。肿瘤靠近胸壁的病人(P=0.0009)、消融区累及脏层胸膜的病人(P=0.039)更容易发生骨折。由于RFA和MWA引起肋骨骨折的病人中,未见报道发生骨折相关的脏器损害,但有9.1%(2/22例)的病人有轻度疼痛。结论肺肿瘤病人在经皮RFA和MWA治疗后13.5%出现肋骨骨折。对那些消融区靠近胸壁的病人需监测肋骨骨折情况。
Objective To retrospectively confirm the incidence and possible risk factors of rib fractures after percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) in patients with lung tumors and to confirm the complications associated with rib fractures. Materials and Methods The Institutional Review Board approved a retrospective study of HIPAA compliance. A total of 163 patients with 195 lung tumors treated with RFA and / or MWA between February 2004 and April 2010 were enrolled. Radiographers who are accredited by the Committee are retrospectively reviewed with CT images of at least 3-month follow-up to determine whether there is a rib fracture. The generalized estimation equation is used to assess the effects of patient demographics, tumor characteristics, treatment parameters, ablation zone characteristics on the development of rib fractures. A Kaplan-Meier curve was used to assess the time function of the probability of rib fractures following ablation. Patients whose fracture was identified were assessed for their clinical parameters (ie, pain in the ribs or chest, organ damage caused by rib fractures). Results 13.5% (22/163) of the patients found adjacent rib fractures in the ablation zone. The estimated probability of rib fractures is 9% in 1 year and 22% in 3 years. Female patients were more likely to have fractures than male patients after ablation (P = 0.041). Patients with tumors near the chest wall (P = 0.0009) were more likely to have fractures in ablation areas involving the visceral pleura (P = 0.039). Since fracture-related organ damage was not reported in patients with rib fractures caused by RFA and MWA, 9.1% (2/22) of the patients had mild pain. CONCLUSIONS: Laryngeal fractures occurred in 13.5% of patients with lung tumors treated with percutaneous RFA and MWA. For those patients near the chest wall in the ablation zone, rib fractures should be monitored.