Status and progress of cryoablation in the treatment of peripheral lung cancer

doi:10.3877/cma.j.issn.2095-5782.2023.02.013

Abstract

Abstract:

This paper reviews the literatures on cryoablation for peripheral lung cancer from PubMed, Scopus, SinoMed, Chinese Medical Ace Base. This review focuses on the mechanism of cryoablation for lung cancer, the current status and progress of cryoablation in peripheral lung cancer, as well as its advantages and disadvantages, in order to provide more evidence for the application of cryoablation in peripheral lung cancer.

Key words: Peripheral lung cancer, Cryoablation, Interventional Pulmonology

Hongjia Li, Yuenian Xing, Shiyue Li, Changhao Zhong. Status and progress of cryoablation in the treatment of peripheral lung cancer[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2023, 11(02): 172-178.

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References 44

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消融技术	作用机制	优势	不足
射频消融	将射频电极穿刺到病灶中，在高频电流的作用下，病灶组织内部产生热生物学效应，局部温度达到60℃以上，使蛋白质变性，细胞发生凝固性坏死	RFA电极适形性好；空气隔热可保护部分周围正常组织；临床应用较广	热沉降效应、受血流和气道影响较大，消融区域易碳化，导致阻抗升高，不利于能量传导，导致消融范围局限，消融时间长；有植入电生理装置的患者不建议使用
微波消融	微波电磁场作用下，肿瘤组织内水分子、蛋白质分子等极性分子产生极高速振动，造成分子之间的相互碰撞、相互摩擦，短时间内产生60~150℃的高温，使肿瘤发生凝固性坏死	无热沉降效应；消融时间短、消融范围大；微波电磁场传导及分布较RFA更快、更均匀，因此升温速率快、热能分布均匀	消融范围受组织性质如含水量影响大，术前预判消融效能有一定难度，需影像学动态监测；临床操作中易因功率过大、消融时间过长引起空洞、气胸出现
冷冻消融	利用超低温（-170℃至-140℃）的消融方式，使肿瘤局部快速冻结导致细胞内和细胞外的冰晶形成，从而破坏肿瘤细胞	消融范围边界清晰，易于监测；单针或多针治疗适形性更强；可用于已植入电生理装置的患者；诱导较强的免疫反应，可增敏全身抗瘤治疗	"冷休克""热池效应"；术后易出现发热；凝血因子损耗出血风险增加

消融技术	作用机制	优势	不足
射频消融	将射频电极穿刺到病灶中，在高频电流的作用下，病灶组织内部产生热生物学效应，局部温度达到60℃以上，使蛋白质变性，细胞发生凝固性坏死	RFA电极适形性好；空气隔热可保护部分周围正常组织；临床应用较广	热沉降效应、受血流和气道影响较大，消融区域易碳化，导致阻抗升高，不利于能量传导，导致消融范围局限，消融时间长；有植入电生理装置的患者不建议使用
微波消融	微波电磁场作用下，肿瘤组织内水分子、蛋白质分子等极性分子产生极高速振动，造成分子之间的相互碰撞、相互摩擦，短时间内产生60~150℃的高温，使肿瘤发生凝固性坏死	无热沉降效应；消融时间短、消融范围大；微波电磁场传导及分布较RFA更快、更均匀，因此升温速率快、热能分布均匀	消融范围受组织性质如含水量影响大，术前预判消融效能有一定难度，需影像学动态监测；临床操作中易因功率过大、消融时间过长引起空洞、气胸出现
冷冻消融	利用超低温（-170℃至-140℃）的消融方式，使肿瘤局部快速冻结导致细胞内和细胞外的冰晶形成，从而破坏肿瘤细胞	消融范围边界清晰，易于监测；单针或多针治疗适形性更强；可用于已植入电生理装置的患者；诱导较强的免疫反应，可增敏全身抗瘤治疗	"冷休克""热池效应"；术后易出现发热；凝血因子损耗出血风险增加

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