Kim Daniel H, Chen Lucia, Lamba Ashley, Abtin Fereidoun, Genshaft Scott, Quirk Matthew, Suh Robert
Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
Department of Medicine Statistics Core, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
J Vasc Interv Radiol. 2025 Jan;36(1):58-65.e1. doi: 10.1016/j.jvir.2024.08.029. Epub 2024 Oct 9.
To evaluate the effectiveness of track cautery for lung microwave ablation (MWA) to reduce postprocedural adverse events (AE).
Patients who underwent percutaneous lung MWA between 2012 and 2021 were divided into 2 cohorts: patients in whom track cautery was conducted during antenna removal and patients in whom the antenna was simply removed. Patient demographics, treatment history, tumor characteristics, and ablation details were collected. Postprocedural AEs including immediate, enlarging, and delayed pneumothorax (PTX), pleural effusion, and reinterventions were recorded. Univariate and multivariate logistic regression models were used to identify factors associated with AEs.
This study included 365 lung MWA sessions for 190 patients. Of the 165 patients in the cautery cohort, 78 (47%) had immediate PTX, 16 (10%) had enlarging PTX, 2 (1%) had delayed PTX, and 15 (9%) needed interventions. Of the 200 patients in the noncautery cohort, 85 (43%) had immediate PTX, 45 (23%) had enlarging PTX, 16 (8%) had delayed PTX, and 37 (19%) needed interventions. The cautery cohort had significantly reduced rates of enlarging PTX (odds ratio [OR], 0.67; 95% CI, 0.34-1.33; P = .002), delayed PTX (OR, 0.15; 95% CI, 0.03-0.89; P = .037), and pleural effusion (OR, 0.38; 95% CI, 0.15-0.99; P = .049). The presence of emphysema, large tumor size, and left lower lobe location were shown to be significant predictors of AEs and the need for interventions (P < .05).
Track cauterization is associated with reduction of post-MWA enlarging PTX, delayed PTX, and pleural effusion. Presence of emphysema, lack of track cautery, large tumor size, and tumors in the left lower lobe were shown to be predictors of postprocedural AEs.
评估肺微波消融（MWA）过程中通道烧灼术减少术后不良事件（AE）的有效性。
将2012年至2021年间接受经皮肺MWA的患者分为2组：在移除天线时进行通道烧灼术的患者和仅移除天线的患者。收集患者的人口统计学资料、治疗史、肿瘤特征和消融细节。记录术后不良事件，包括即刻、进展性和延迟性气胸（PTX）、胸腔积液及再次干预情况。采用单因素和多因素逻辑回归模型确定与不良事件相关的因素。
本研究纳入了190例患者的365次肺MWA治疗。在通道烧灼术组的165例患者中，78例（47%）发生即刻PTX，16例（10%）发生进展性PTX，2例（1%）发生延迟性PTX，15例（9%）需要干预。在非通道烧灼术组的200例患者中，85例（43%）发生即刻PTX，45例（23%）发生进展性PTX，16例（8%）发生延迟性PTX，37例（19%）需要干预。通道烧灼术组进展性PTX（比值比[OR]，0.67；95%可信区间[CI]，0.34 - 1.33；P = 0.002）、延迟性PTX（OR，0.15；95% CI，0.03 - 0.89；P = 0.037）和胸腔积液（OR，0.38；95% CI，0.15 - 0.99；P = 0.049）的发生率显著降低。肺气肿、肿瘤体积大及位于左下叶被证明是不良事件及需要干预的显著预测因素（P < 0.05）。
通道烧灼术与MWA术后进展性PTX、延迟性PTX和胸腔积液的减少相关。肺气肿的存在、未进行通道烧灼术、肿瘤体积大及肿瘤位于左下叶被证明是术后不良事件的预测因素。
