摘要: 背景：近年来，肺癌的发病率和死亡率在全球所有恶性肿瘤中是最高的。针对早期及中期的肺癌，手术仍是临床治疗的首选，然而只有约20%~30%的患者可以进行手术。对于一般身体状况差，心肺功能欠佳，多种慢性基础疾病缠身等拥有明确手术禁忌症或出于主观恐惧以及受限于经济条件无法行手术治疗的患者来说，消融不失为一种有效的治疗方案。目的：本研究旨在对CT引导下微波消融术治疗肺恶性肿瘤的有效性及安全性进行统计和相关因素分析，并找出影响MWA近期疗效的相关因素，探究MWA治疗肺恶性肿瘤的临床规律。方法：本研究收集了2019年1月至2022年6月就诊于大连医科大学附属第二医院的50例患者的资料。所有患者均行CT引导下微波消融术。收集患者的基线资料如年龄、性别、肿瘤直径、肿瘤部位、手术时间、消融能量、肿瘤距胸膜的距离、病理类型等数据，并进行统计学分析得到结果，对统计学结果进行分析研究，最终得出结论。针对收集到的患者各项基础数据资料，应用中文版SPSS26.0软件进行处理，按照统计学规范，合理运用t检验、秩和检验、logistic回归分析等方法，检验标准为P < 0.05。结果：经过本研究入组条件和排除条件的筛选后，共有50例患者满足条件，均行CT引导下微波消融术。其中顺利完成MWA 49例(49/50, 98.00%)，手术成功率为98.00%。MWA术后3个月疗效评价：完全缓解(complete response, CR)：25例(51.0%, 23/49)，部分缓解(partial response, PR)：15例(30.6%, 15/49)，疾病稳定(stable disease, SD)：8例(16.3%, 8/49)，疾病进展(progressive disease, PD)：1例(2.0%, 1/49)。有效率为81.6%，疾病控制率为97.9%。MWA术后6个月疗效评价CR：30例(61.2%, 30/49)，PR：12例(24.5%, 12/49)，SD：4例(8.2%, 4/49)，PD：3例(6.1%, 3/49)。有效率 = 85.7%，疾病控制率 = 93.9%。以MWA术后第6个月为近期疗效终点，对可能影响近期疗效的各相关因素进行单因素分析，年龄，性别，肿瘤类型，消融体位，消融总能量，肿瘤距胸膜的距离，有无肺气肿，手术时长，有无气胸，P > 0.05均无统计学意义。肿瘤直径(P = 0.001)，结节类型(P = 0.037)，P < 0.05有统计学意义。将单因素分析有意义的因素带入有序回归分析中，得出肿瘤直径(P = 0.007)，P < 0.05，具有统计学意义，且为正相关因素，即肿瘤直径越大近期疗效越差。结论：1) MWA治疗肺恶性肿瘤近期疗效确切，有效率及疾病控制率较高；2) 肿瘤直径为影响近期疗效的相关因素，肿瘤直径越大，近期疗效越差。
Abstract:
Background: In recent years, lung cancer has had the highest incidence and mortality rate of all malignancies worldwide. For early and intermediate stage lung cancer, surgery remains the first choice of clinical treatment, yet only about 20%~30% of patients can undergo surgery. Ablation is an effective treatment option for patients who are generally in poor health, have poor cardiopul-monary function, have multiple chronic underlying diseases, have clear contraindications to sur-gery or have a perceived fear of surgery and are unable to afford it. Objective: The aim of this study was to conduct statistical and correlative factor analysis on the effectiveness and safety of CT-guided microwave ablation in the treatment of pulmonary malignancies, and to find out the relevant fac-tors affecting the recent efficacy and complications of MWA, and to investigate the clinical pattern of MWA in the treatment of pulmonary malignancies. Methods: This study collected data from 50 pa-tients who attended the Second Affiliated Hospital of Dalian Medical University from January 2019 to June 2022. All patients underwent CT-guided microwave ablation. Baseline data such as age, gender, tumour diameter, tumour site, operation time, ablation energy, distance of the tumour from the pleura, pathological type and other data were collected from the patients and statistical analysis was performed to obtain the results, and the statistical results were analysed and studied to draw the final conclusions. For the various basic data collected from the patients, the Chinese version of SPSS26.0 software was applied to process them, and t-test, rank sum test, logistic regression analy-sis were reasonably used according to statistical norms, and the test standard was P < 0.05. Results: After screening for inclusion and exclusion criteria, a total of 50 patients met the criteria and all underwent CT-guided microwave ablation. Among them, 49 cases of MWA were successfully com-pleted (49/50, 98.00%), and the success rate of the procedure was 98.00%. 3 months after MWA, the efficacy evaluation: complete response (CR): 25 cases (51.0%, 23/49), partial response (PR): 15 cases (30.6%, 15/49), the number of patients with stable disease (SD): 8 cases (16.3%, 8/49), pro-gressive disease (PD): 1 (2.0%, 1/49). The efficacy rate was 81.6%, and the disease control rate was 97.9%. 6 months after MWA the efficacy evaluation was CR: 30 cases (61.2%, 30/49), PR: 12 cases (24.5%, 12/49), SD: 4 cases (8.2%, 4/49), PD: 3 cases (6.1%, 3/49). Efficacy rate = 85.7% and dis-ease control rate = 93.9%. Using 6 months after MWA as the immediate efficacy endpoint, univari-ate analysis was performed for each relevant factor that might affect immediate efficacy, age, gen-der, tumour type, ablation position, total ablation energy, distance of the tumour from the pleura, presence of emphysema, duration of surgery, presence of pneumothorax, P > 0.05 were not statisti-cally significant. Tumour diameter (P = 0.001), nodule type (P = 0.037), P < 0.05 were statistically significant. Bringing the factors that were significant in the univariate analysis into the ordered re-gression analysis yielded a statistically significant and positive correlation for tumour diameter (P = 0.007), P < 0.05, i.e. the larger the tumour diameter, the worse the recent outcome. Conclusion: 1) MWA is effective in the treatment of pulmonary malignancies, with high efficiency and disease con-trol rates. 2) Tumour diameter is a relevant factor affecting the recent efficacy, the larger the tu-mour diameter, the worse the recent efficacy.