Maiwand M O, Asimakopoulos G
Department of Thoracic Surgery, Harefield Hospital, Harefield, Middlesex, England.
Technol Cancer Res Treat. 2004 Apr;3(2):143-50. doi: 10.1177/153303460400300207.
Lung carcinoma is the most frequently diagnosed malignancy in the world, with the incidence increasing through the 20th century. Presentation may be as a tumor mass primarily obstructing the central bronchial lumen, or a mass infiltrating lung tissue. Cryosurgery can be used as a method of palliative treatment for both these endobronchial and extrabronchial presentations. The aim of this study is two-fold: to present data relating to our extensive experience in treating obstructing endobronchial tumors and to present our initial results of direct cryosurgery to infiltrating lung tumor masses. During a nine-year period, 521 consecutive patients (male:female ratio 1.8:1) with a mean age of 67.9 years who had advanced obstructive tracheobronchial malignant tumors underwent cryosurgery with a mean of 2.4 treatments per patient. Hemoptysis, cough, dyspnoea and chest pain improved by at least one class in 76.4%, 69.0%, 59.25% and 42.6% (p<0.01) of symptomatic patients respectively. Quality of life studies showed that the mean Karnofsky score improved from 60 +/- 7 to 75 +/- 8 and the mean WHO score from 3.04 +/- 0.7 to 2.20 +/- 0.56. There were 7 (1.2%) in-hospital deaths, and 2-year survival was 15.9%. Direct cryosurgery to carcinoma of the lung was performed on 15 patients at exploratory thoracotomy. Results showed an increase in FEV1 from 1.80 +/- 0.6 liters to 1.95 +/- 0.8 (8.3%) liters and in FVC from 2.50 +/- 0.8 to 2.68 +/- 0.8 liters (7.2%). The Karnofsky score improved from 68 +/- 9 to 78 +/- 10 and the WHO score from 2.63 +/- 0.81 to 2.38 +/- 0.78 (9.6%). Major symptoms including cough, dyspnoea, and hemoptysis were assessed and showed improvement in 77.8%, 66.7%, and 100% (p<0.01) of symptomatic patients respectively. Patients were followed for a mean period of 18 months (range 4-84 months). Median survival from the date of surgery (Kaplan-Meier, 95%Cl) was 11.6 (6.8 to 18.2) months, range 1 to 84 months. Cryosurgery provides a safe and effective method for the palliation of advanced central bronchial obstructive tumors, and compares favorably with other methods in terms of safety, cost, and complications. Initial experience suggests that similar palliation may be achieved by cryosurgery applied to advanced parenchymal tumor masses.
肺癌是全球最常被诊断出的恶性肿瘤，其发病率在20世纪呈上升趋势。临床表现可能为主要阻塞中央支气管腔的肿瘤肿块，或浸润肺组织的肿块。冷冻手术可作为治疗这两种支气管内和支气管外表现的姑息治疗方法。本研究的目的有两个：一是呈现我们在治疗阻塞性支气管内肿瘤方面的丰富经验相关数据，二是展示我们对浸润性肺肿瘤肿块进行直接冷冻手术的初步结果。在九年期间，521例连续患者（男女比例为1.8:1），平均年龄67.9岁，患有晚期阻塞性气管支气管恶性肿瘤，接受了冷冻手术，每位患者平均接受2.4次治疗。咯血、咳嗽、呼吸困难和胸痛在有症状的患者中分别改善了至少一个等级，比例分别为76.4%、69.0%、59.25%和42.6%（p<0.01）。生活质量研究表明，卡诺夫斯基评分平均从60±7提高到75±8，世界卫生组织评分从3.04±0.7提高到2.20±0.56。有7例（1.2%）住院死亡，两年生存率为15.9%。对15例患者在开胸探查时对肺癌进行了直接冷冻手术。结果显示第一秒用力呼气容积从1.80±0.6升增加到1.95±0.8升（8.3%），用力肺活量从2.50±0.8升增加到2.68±0.8升（7.2%）。卡诺夫斯基评分从68±9提高到78±10，世界卫生组织评分从2.63±0.81提高到2.38±0.78（9.6%）。对包括咳嗽、呼吸困难和咯血在内的主要症状进行了评估，有症状的患者中分别有77.8%、66.7%和100%（p<0.01）出现改善。患者平均随访18个月（范围4 - 84个月）。从手术日期起的中位生存期（Kaplan - Meier，95%置信区间）为11.6（6.8至18.2）个月，范围为1至84个月。冷冻手术为晚期中央支气管阻塞性肿瘤的姑息治疗提供了一种安全有效的方法，在安全性、成本和并发症方面与其他方法相比具有优势。初步经验表明，对晚期实质性肿瘤肿块应用冷冻手术可能实现类似的姑息治疗效果。
