Zhang Jianxiang, Xu Kaihao, Du Kepu, Han Xinwei, Jiao Dechao
Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Quant Imaging Med Surg. 2023 Oct 1;13(10):7214-7224. doi: 10.21037/qims-23-138. Epub 2023 Sep 7.
The conventional diagnosis and treatment for highly suspected malignant pulmonary nodules (PNs) can avoid unnecessary treatment to some extent. However, the relatively separate puncture processes may not only increase puncture-related complications, but also increase the patient's radiation exposure and hospitalization costs. The purpose of this study was to retrospectively analyze the effectiveness of simultaneous percutaneous microwave ablation (MWA) and percutaneous biopsy (PB) for PNs.
From August 2015 to August 2022, 65 consecutive patients [48 solid nodules, 6 ground glass opacities (GGOs), 11 mixed nodules] with suspected single malignant PN underwent MWA and PB combination treatments at the First Affiliated Hospital of Zhengzhou University. The total of 30 patients in Group A underwent synchronous PB and MWA (strategy: low-power MWA-PB-high-power MWA), whereas 35 patients in Group B underwent asynchronous PB and MWA. The technical success, complete ablation (CA), complications, total procedure time (TPT), patient exposure dose (PED), hospitalization time, and costs were compared. An independent samples , χ, or Fisher's exact tests were used.
The technical success (100% 100%) and CA (100% 97.1%) rates were not significantly different between Groups A and B. The complications of intrapulmonary hemorrhage (16.7% 41.4%, P=0.02) and hemoptysis (0% 8.6%, P=0.04) were significantly different between Groups A and B. TPT (41.6±7.9 57.3±8.8 min, P<0.001), PED (12.9±1.4 19.4±2.3 mSv, P<0.001), hospitalization stay (4.7±1.3 9.1±2.1 days, P<0.001) and costs (3,768.8±652.9 4,508.0±514.1 USD, P<0.001) also showed significant differences between Groups A and B.
Synchronous PB and MWA for PNs is a safe and effective strategy that can decrease bleeding, PED, the hospitalization stay, and costs.
对于高度怀疑的恶性肺结节（PNs），传统的诊断和治疗在一定程度上可以避免不必要的治疗。然而，相对独立的穿刺过程不仅可能增加与穿刺相关的并发症，还会增加患者的辐射暴露和住院费用。本研究的目的是回顾性分析经皮微波消融（MWA）与经皮活检（PB）同步进行治疗PNs的有效性。
2015年8月至2022年8月，郑州大学第一附属医院连续65例怀疑为单个恶性PN的患者[48个实性结节、6个磨玻璃影（GGO）、11个混合性结节]接受了MWA和PB联合治疗。A组30例患者接受PB与MWA同步进行（策略：低功率MWA-PB-高功率MWA），而B组35例患者接受PB与MWA不同步进行。比较两组的技术成功率、完全消融（CA）、并发症、总手术时间（TPT）、患者暴露剂量（PED）、住院时间和费用。采用独立样本t检验、χ²检验或Fisher精确检验。
A组和B组的技术成功率（100%对100%）和CA率（100%对97.1%）无显著差异。A组和B组的肺内出血并发症（16.7%对41.4%，P = 0.02）和咯血并发症（0%对8.6%，P = 0.04）有显著差异。TPT（41.6±7.9对57.3±8.8分钟，P < 0.001）、PED（12.9±1.4对19.4±2.3 mSv，P < 0.001）、住院天数（4.7±1.3对9.1±2.1天，P < 0.001）和费用（3768.8±652.9对4508.0±514.1美元，P < 0.001）在A组和B组之间也显示出显著差异。
PNs的PB与MWA同步进行是一种安全有效的策略，可减少出血、PED、住院天数和费用。
