Maiwand M O, Evans J M, Beeson J E
Department of Thoracic Surgery, Harefield Hospital, Harefield, Middlesex UB9 6JH, UK.
Cryobiology. 2004 Feb;48(1):55-61. doi: 10.1016/j.cryobiol.2003.12.003.
Lung cancer is the commonest cause of cancer death, with a very poor survival rate. By the time of diagnosis, most cases are at an advanced stage and about 30% present with symptoms caused by central endobronchial obstruction. Endobronchial cryosurgery is an effective technique, which can be used to relieve tracheobronchial obstruction caused by lung cancer. This report describes the technique, using a nitrous oxide cooled cryoprobe, inserted through a bronchoscope, to remove the obstruction and reopen the airway. In this study, 476 consecutive patients (mean age 68.3 years, M:F ratio 1.9:1) with obstructive tracheobronchial tumours underwent a mean of 2.4 cryosurgical treatments. Their TNM staging was, stage II 6.7%, IIIa 21.0%, IIIb 23.9%, IV 48.4%. Improvement in symptom quantification was found with 76.4, 69.0, 59.2, and 42.6% of symptomatic patients for haemoptysis, cough, dyspnoea, and chest pain, respectively. Mean values for respiratory function improved from 1.38 to 1.41 litres for FEV1 and 1.91 to 2.04 litres for FVC (p </= 0.0001). Mean performance status improved from 59.6 to 75.2 for Karnofsky scale and 3.04 to 2.20 for the WHO scale and the complication rate was 3.5% of treatments. The Kaplan-Meier median survival was 8.2 months and 1- and 2-year survival 38.4 and 15.9%, respectively. Survival analysis suggested a possible survival advantage over alternative palliative techniques. Endobronchial cryosurgery provides a safe and effective method for the palliation of otherwise inoperable lung cancer. It has advantages over other methods in terms of safety, cost, and a low complication rate. Cryosurgery can be repeated as often as required.
肺癌是癌症死亡的最常见原因，生存率极低。在确诊时，大多数病例已处于晚期，约30%的患者出现由中央支气管内阻塞引起的症状。支气管内冷冻手术是一种有效的技术，可用于缓解肺癌引起的气管支气管阻塞。本报告描述了该技术，即使用通过支气管镜插入的一氧化二氮冷却冷冻探头来清除阻塞并重新开通气道。在本研究中，476例连续性阻塞性气管支气管肿瘤患者（平均年龄68.3岁，男女比例1.9:1）平均接受了2.4次冷冻手术治疗。他们的TNM分期为：II期6.7%，IIIa期21.0%，IIIb期23.9%，IV期48.4%。咯血、咳嗽、呼吸困难和胸痛的症状性患者症状量化改善率分别为76.4%、69.0%、59.2%和42.6%。呼吸功能的平均值，第一秒用力呼气容积（FEV1）从1.38升提高到1.41升，用力肺活量（FVC）从1.91升提高到2.04升（p≤0.0001）。卡诺夫斯基量表的平均表现状态从59.6提高到75.2，世界卫生组织量表从3.04提高到2.20，并发症发生率为治疗次数的3.5%。卡普兰 - 迈耶中位生存期为8.2个月，1年和2年生存率分别为38.4%和15.9%。生存分析表明，与其他姑息治疗技术相比可能具有生存优势。支气管内冷冻手术为无法手术的肺癌姑息治疗提供了一种安全有效的方法。在安全性、成本和低并发症发生率方面，它比其他方法具有优势。冷冻手术可根据需要多次重复进行。
