本文選題：肺部惡性腫瘤 + 療效�。� 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)51例接受CT引導(dǎo)下經(jīng)皮氬氦刀冷凍消融治療的肺原發(fā)或轉(zhuǎn)移性惡性腫瘤患者進(jìn)行療效評(píng)價(jià),包括瘤灶大小變化、臨床癥狀、體能狀態(tài)、并發(fā)癥等方面,探討氬氦刀冷凍消融技術(shù)治療肺部惡性腫瘤的有效性及安全性。方法:采用回顧性的研究方法收集2013年11月-2016年12月期間在中日友好醫(yī)院中西醫(yī)結(jié)合腫瘤內(nèi)科接受CT引導(dǎo)下經(jīng)皮氬氦刀冷凍消融治療的51例肺部惡性腫瘤患者的臨床資料,分析氬氦刀冷凍消融治療前后患者的癥狀、體能狀態(tài)和影像學(xué)結(jié)果改變,統(tǒng)計(jì)術(shù)中術(shù)后不良反應(yīng)及相關(guān)中醫(yī)藥治療方法,并追蹤冷凍術(shù)后患者的生存期和生存率情況。結(jié)果:1.實(shí)體瘤療效評(píng)定:51例肺部腫瘤病灶,直徑最大為90.07mmm,最小為13.03mm。將患者氬氦刀治療前的影像結(jié)果與距離2017年4月前最近的一次復(fù)查的影像結(jié)果相比較,其中復(fù)查時(shí)間最長(zhǎng)1366天,最短21天。根據(jù)RECIST1.1實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)進(jìn)行評(píng)價(jià),客觀有效率(CR+PR)15.69%,疾病控制率(CR+PR+SD)84.31%。2.體能狀態(tài)評(píng)價(jià):根據(jù)Karnofsky功能狀態(tài)評(píng)分標(biāo)準(zhǔn),觀察患者治療前后的功能狀態(tài)改變情況。治療后1周功能狀況改善的13例(25.49%),較術(shù)前無明顯變化的33例(64.71%),體能狀況變差的5例(9.80%)。提高+穩(wěn)定率為90.2%。3.臨床癥狀變化:取肺癌八個(gè)常見癥狀,結(jié)合患者病情,觀察治療后1周患者相應(yīng)癥狀的改變程度�？人跃徑�7例(36.84%),咳痰緩解6例(50.0%),咯血或痰中帶血緩解3例(30.0%),胸痛緩解11例(84.60%),乏力緩解27例(56.25%),氣短緩解29例(63.04%),胸悶憋氣緩解5例(26.32%),食欲不振緩解 4 例(14.29%)。4.并發(fā)癥:51例患者均順利完成手術(shù),出現(xiàn)氬氦刀冷凍消融治療相關(guān)并發(fā)癥者37例,總體并發(fā)癥發(fā)生率為72.55%。其中,氣胸9例,發(fā)熱6例,咳嗽4例,咳血6例,畏寒怕冷2例,食欲不振3例,術(shù)后疼痛5例,血胸1例,出血所致窒息1例,無手術(shù)相關(guān)死亡發(fā)生。術(shù)后輔以中草藥湯劑治療,以"益氣健脾、清肺散結(jié)"為治則,辨證加減用藥。所有患者在2周內(nèi)病情好轉(zhuǎn)。結(jié)論:1.氬氦刀冷凍消融治療肺原發(fā)或轉(zhuǎn)移性惡性腫瘤療效確切,可快速減輕腫瘤負(fù)荷,延緩腫瘤進(jìn)展,改善患者不適癥狀,提高生活質(zhì)量。2.氬氦刀冷凍消融治療適應(yīng)證廣,創(chuàng)傷小,患者耐受度好,并發(fā)癥輕微,術(shù)后恢復(fù)快。與放化療或中醫(yī)藥等手段聯(lián)合應(yīng)用,安全有效,值得進(jìn)一步研究并在臨床上推廣。
[Abstract]:Objective: to evaluate the curative effect of 51 patients with primary or metastatic lung cancer treated by CT guided cryoablation with argon and helium knife, including the changes of tumor focus, clinical symptoms, physical condition, complications and so on. To evaluate the efficacy and safety of argon-helium ablation technique in the treatment of pulmonary malignant tumors. Methods: from November 2013 to December 2016, 51 patients with pulmonary malignant tumors who were treated with CT-guided cryoablation with argon and helium knife were collected retrospectively from November 2013 to December 2016 in the Department of Oncology of Integrated Chinese and Western Medicine in Sino-Japanese Friendship Hospital. The symptoms, physical condition and imaging results of patients before and after cryoablation with argon-helium knife were analyzed. The adverse reactions during and after cryopreservation were analyzed. The survival time and survival rate of patients after cryopreservation were followed up. The result is 1: 1. The curative effect of solid tumor was evaluated in 51 cases of pulmonary tumor. The maximum diameter was 90.07 mm and the smallest was 13.03 mm. The imaging results of the patients before Argon-helium knife treatment were compared with those of the most recent reexamination before April 2017. The longest time of reexamination was 1366 days and the shortest was 21 days. According to the evaluation criteria of RECIST1.1 solid tumor curative effect, the objective effective rate was 15.69%, and the disease control rate was 84.31%. 2. Physical state evaluation: according to Karnofsky functional state score, the changes of patients' functional state before and after treatment were observed. One week after treatment, 13 patients with improved functional status were 25.49m, compared with 33 patients who had no obvious change before treatment, and 5 patients with poor physical fitness. The stability rate was increased to 90.20.3. Changes of clinical symptoms: eight common symptoms of lung cancer were taken and combined with patients' condition to observe the degree of change of corresponding symptoms 1 week after treatment. There were 7 cases of cough relief, 6 cases of expectoration relief, 3 cases of hemoptysis or sputum with blood relief, 3 cases of hemoptysis and sputum with blood relief, 11 cases of relief of chest pain, 11 cases of relief of chest pain, 56.25 cases of relief of asthenia, 29 cases of relief of shortness of breath, 5 cases of relief of shortness of breath, 4 cases of anorexia and 4 cases of anorexia. All 51 cases of complications were successfully completed, 37 cases had complications associated with cryoablation of argon and helium knife, the overall incidence of complications was 72.55%. There were 9 cases of pneumothorax, 6 cases of fever, 4 cases of cough, 6 cases of hemoptysis, 2 cases of chills and chills, 3 cases of anorexia, 5 cases of postoperative pain, 1 case of hemothorax and 1 case of asphyxia caused by hemorrhage. After operation with Chinese herbal medicine decoction treatment, "invigorating qi and spleen, clearing the lung and dispersing knot" as the treatment principle, differentiation of symptoms and signs plus or minus medication. All patients improved within 2 weeks. Conclusion 1. Argon-helium ablation is effective in the treatment of primary or metastatic lung neoplasms. It can reduce tumor load, delay tumor progression, improve uncomfortable symptoms and improve quality of life (QOL). Argon-helium cryoablation has the advantages of wide indication, small trauma, good tolerance, slight complications and quick recovery. Combined with radiotherapy and chemotherapy or traditional Chinese medicine, it is safe and effective, and worth further study and clinical promotion.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2

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本文編號(hào)：1842110