Asimakopoulos George, Beeson Julia, Evans Joanna, Maiwand M Omar
Department of Thoracic Surgery, Harefield Hospital, Harefield, Middlesex UB9 6JH, UK.
Chest. 2005 Jun;127(6):2007-14. doi: 10.1378/chest.127.6.2007.
More than 80% of patients with lung cancer are unsuitable for curative surgical treatment. Palliative relief of symptoms, often caused by airway obstruction, is very important. Endobronchial cryosurgery is used for destruction of intraluminal tumors. This study analyzes the effects of cryosurgery on patients with obstructive endobronchial carcinoma.
Retrospective analysis of data extracted from a prospective computerized database.
Tertiary referral thoracic surgical center.
Data of the 172 patients who underwent at least two sessions of endobronchial cryosurgery (group A) were compared with 157 patients who underwent one session of cryosurgery (group B) for malignant primary or metastatic obstructive lung carcinoma over a 5-year period.
Endobronchial cryosurgery is performed under general anesthesia. A nitrous oxide cryoprobe is inserted through a rigid bronchoscope. The probe achieves a temperature of - 70 degrees C at its tip and is applied to the tumor for two 3-min periods. Statistical analysis assessed the effects of cryosurgery on symptoms, lung function, Karnofsky performance score, and survival.
Symptoms of dyspnea, cough, and hemoptysis were significantly reduced in both groups after cryosurgery (p < 0.001), although group A benefited more than group B. Lung function test results improved significantly in group A. The mean Karnofsky performance score (+/- SD) increased from 67 +/- 9 to 74 +/- 10 (group A) and from 67 +/- 10 to 73 +/- 11 (group B). The mean survival was 15 months (median, 11 months) for group A and 8.3 months (median, 6 months) for group B (p = 0.006). Univariate regression analysis showed that no particular patient or tumor characteristic was associated with reduction of symptoms. Patients who had cryosurgery and external beam radiotherapy showed longer survival (p < 0.01). Females and patients with stage IIIa and IIIb tumors achieved significantly improved Karnofsky scores (p < 0.02). Female sex was also a factor for increase in FEV at 1 min (p = 0.003) and FVC (p < 0.001).
Cryosurgery is a safe method for palliation of endobronchial malignancies causing airway obstruction. Statistical analysis showed improvement of dyspnea, cough, and hemoptysis. Cryosurgery can be considered in patients with inoperable obstructive endobronchial carcinoma.
超过80%的肺癌患者不适合进行根治性手术治疗。缓解通常由气道阻塞引起的症状非常重要。支气管内冷冻手术用于破坏腔内肿瘤。本研究分析了冷冻手术对阻塞性支气管内癌患者的影响。
对从前瞻性计算机数据库中提取的数据进行回顾性分析。
三级转诊胸外科中心。
将172例至少接受过两次支气管内冷冻手术的患者（A组）的数据与157例接受过一次冷冻手术的患者（B组）的数据进行比较，这些患者在5年期间患有原发性或转移性恶性阻塞性肺癌。
支气管内冷冻手术在全身麻醉下进行。通过硬支气管镜插入一氧化二氮冷冻探头。探头尖端温度可达-70℃，并将其应用于肿瘤，每次持续3分钟，共两次。统计分析评估了冷冻手术对症状、肺功能、卡诺夫斯基表现评分和生存率的影响。
两组患者冷冻手术后呼吸困难、咳嗽和咯血症状均显著减轻（p<0.001），尽管A组获益比B组更多。A组肺功能测试结果显著改善。A组卡诺夫斯基表现评分（±标准差）从67±9提高到74±10，B组从67±10提高到73±11。A组平均生存期为15个月（中位数为11个月），B组为8.3个月（中位数为6个月）（p=0.006）。单因素回归分析表明，没有特定的患者或肿瘤特征与症状减轻相关。接受冷冻手术和外照射放疗的患者生存期更长（p<0.01）。女性以及患有Ⅲa期和Ⅲb期肿瘤的患者卡诺夫斯基评分显著提高（p<0.02）。女性也是1分钟用力呼气容积（p=0.003）和用力肺活量（p<0.001）增加的一个因素。
冷冻手术是缓解导致气道阻塞的支气管内恶性肿瘤的一种安全方法。统计分析表明呼吸困难、咳嗽和咯血症状得到改善。对于无法手术的阻塞性支气管内癌患者可考虑采用冷冻手术。
