| Background and purposeLung cancer occupys the highest mortality of malignant tumor in recent years.Because of the environmental pollution and atmospheric haze nowday,The incidence of lung cancer is higher than before,and has been the largest cancer in China.Lung cancer is divided into primary and secondary.The treatment include surgery,radiation therapy,chemotherapy and combined therapy.And,because of a variety of reasons(physical condition is too poor to tolerate surgery,unresectable lesions,multiple transfers,merging lesions outside the chest and other),patient of advanced lung cancer often miss the best surgical treatment time.So integrated treatment of advanced cancer hold a dominant position,in which microwave ablation operation of lung tumor development quickly,it has little trauma?high security?applies crowd widely?less complications?patients recovery fast?patients easy tolerance and with simple and safe operation,but it still has some chances occurred complications,such as pneumothorax?chest product liquid?skin gas swollen?lung empty?lung abscess?bleeding?breathing difficult and other serious complication seven death,.So how to reduce complications occurred in intraoperative and postoperative andwhat should be done in a timely when complications occur,and influence factors of complications,they are extremely important for reducing the pain of advanced lung cancer patients.Materials and methods:According to the recording of microwave ablation operations,select 105 patients in Affiliated Hospital of Tai shan Medical College from January 2014 to January 2016 using pulmonary microwave ablation treatment,recorded every microwave ablation operation's preparation process operation process,all kinds of complications during and after finishing,such as pain,pneumothorax,hemoptysis,subcutaneous emphysema and their time of occurrence and severity,compare different positions,the needle angle,through the pleural layers and whether through fissural impact with the incidence of various complications;compare patients with changes of CT scan and enhanced(pneumothorax healing,subcutaneous emphysema,pulmonary hemorrhage,inflammation)each microwave ablation of preoperative and intraoperative and postoperative one month?three months?six months in,The patient's family members were followed up by telephone who didn't referral after operation,advisory the complications,if tumor has been transfered,if tumor has been recurrenced and patients' s survival status.Within two years,in 105 cases of with lung cancer in microwave ablation there are male patients 69(69/105),female patients 36(36/105),the average age of the patients is 61 in male(23 to 84),62 in female(52 to 76),primary non-small cell lung cancer accounted for 84 cases(85/105),transfer lung cancer accounted for 18 cases(19/105),1 cases of primary lung cancer with metastatic lung cancer(1/105).ResultsIn 105 cases of microwave ablation of lung cancer,there were 21 cases(20%)had postoperative pneumonia,2 cases of postoperative body temperature higher than 39 degrees celsius,after giving anti infection(cefoperazone sulbactam sodium)treatment the symptoms were improved and cured;12 cases(11.4%)of pulmonary cavity,including 1 cases(0.9%)in which surgery the tumor appeared empty,no postoperative follow-up,4 days after operation appear paroxysmal pain,fever,pain,cooling,after giving temperature reduction?odynolysis?anti infection therapy,the symptoms were improved;Lung cavity were found by CT in 6 cases(5.7%)reexamination one month?2 cases(1.9%)after three months after operation,All cases did not receive special treatment,In which 1 case's CT reexamination showed the hole lung abscess one month after operation,by using pleural fluid aspiration and injection of antibiotics,the symptoms were improved after two weeks;22 cases(20.9%)of pneumothorax,of which 16 cases of mild which self absorped without treatment,of which 4 cases requiring drainage pneumothorax,of which 1 case of mild pneumothorax was heavier after six days,24 days' s drainage pneumothorax the symptoms didn't improved,families requested discharge and symptoms untreated until discharged;6 cases(5.7%)appearanced pleural effusion and then they were giving drainage of pleural puncture,including 1 case with pneumonia,underwent pleural puncture fluid perfusion(group A Streptococcus 5ke injection and levofloxacin)and left-ofloxacin-resistant infection,1 cases in which the liquid is withdrawn for light red bloody fluid,about 40 ml,pathological examination didn't found cancer cells;8 cases(7.6%)with varying degrees of nausea,vomiting,fatigue,poor spirit,poor mood and systemic reactions,after giving improving immunity?phlegm and other cured,the symptoms were improved;2 cases(1.9%)heart rate too fast,high temperature(greater than 38.1 degrees celsius)after operation,after giving dexamethasone the symptoms improved;1 cases'(0.9%)CT said that lesions(microwave ablation mass)were obviously increased compared with pre operation 1 month after operation,right hilar and mediastinum had multiple enlarged lymph nodes,the patient had primary adenocarcinoma,preoperative tumor's maximum ablation was 9.5cm,there were 2 lesions,total ablation time was 20 minutes,the maximum ablation power is 70 W,the abnormal situation did not occur during the operation,CT postoperatived residual tumor after one months;4 cases(3.8%)during and after the operation appeared suffocation,dyspnea and chest tightness,after giving oxygen the symptoms were improved;2 cases(1.9%)had mild subcutaneous emphysema which without special treatment.Accept 1 patient with residual tumor and 1 patients with severe pneumothorax,all cases' symptoms improved after treatment.Non parametric test(Mann-Whitney U test),the differences of the shortest distance from target lesions to parietal pleura?smoking index?maximum tumor diameter?number of lesions?cumulative ablation times?accumulated length through the lung tissue?target lesion?cumulative ablation time and the biggest ablation power between the group with and without pneumonia,the results showed that the shortest distance from target lesions to parietal pleura and smoking index are significant between two groups(P<0.05),that can be considered as the pneumonia group's distance from target lesions to parietal pleura is shorter than the without pneumonia group,the pneumonia group's smoking index is higher than the without pneumonia group.Using the factors of single factor analysis of P<0.1 and professionally have significant:the shortest distance from target lesions to parietal pleura and smoking index are independent variables,the pneumonia occur or not is dependent variable to take ogistic regression analysis,the method is stepwise method,entry and exclusion criteria is 0.05 and 0.10.The results are as follows: the shortest distance from target lesions to parietal pleura?smoking index are independent risk factors of pneumonia.It can be concluded that the distance from target lesions to parietal pleura is shorter,the risk of pneumonia is greater;the greater the smoking index,the greater the risk of pneumonia.Non parametric test(Mann-Whitney U test)compare the differences of the shortest distance from target lesions to parietal pleura?smoking index?maximum tumor diameter?number of lesions?cumulative ablation times?accumulated length through the lung tissue?target lesion?cumulative ablation time and the biggest ablation power between the group with and without pleural fluid,the results showed that the shortest distance from target lesions to parietal pleura is significant(P<0.05),that can be considered as the pleural fluid group's distance from target lesions to parietal pleura is shorter than the without pneumonia group,the pneumonia group's smoking index is higher than the without pleural fluid group.Conclusion and significance:Microwave ablation of lung tumors is a relatively safer treatment than others,but it may also cause some complications,most complications does not need to be processed or easily to be handled,the prognosis is good,do not need to to limit microwave ablation because of this.For male patients with emphysema,lesions near the pleura,a large volume of lung tumors,operating of microwave ablation of lung tumors should be careful.How to reduce the lung tumor microwave ablation complications:1.Assess the location and size of the tumor and patient's lung function status correctly to determine the puncture scheme;2.Pleural puncture needle should be pierced into vertically to reduce the injury area of pleural;3.Choosing the route which pass through lower number of plies of pleura to reduce damage of pleural;4.Avoiding the needle pass through the leaves crack to reduce the occurrence of pneumothorax;5.Avoiding bronchial and vascular can reduce the risk of bleeding;6.Using hemostatic drugs by advance and predicting the small blood vessels may encounter can reduce the risk of pulmonary hemorrhage,pulmonary validation;7.Selecting suitable ablation power and time,reduce the incidence of pulmonary cavities;8.Patients with diabetes or low autoimmune should take preoperative antibiotic prophylaxis to prevent the occurrence of lung infection.The topic is aim to study the complications in and post operative of microwave ablation of lung tumor,complications of MWA and its treatment?the impact of influence factors,which can promote carring out microwave ablation of lung tumors more smoothly. |
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