| [Objective]By observing the long-term postoperative efficacy and complications of argon-helium cryoablation in patients with primary lung cancer and the control of tumors in different ablation ranges in the aspects of age,tumor size,pathological type,clinical stage and anatomical structure to explore the effects of different cryoablation ranges on tumor control.[Methods]A retrospective study was performed to collect 151 patients with primary lung cancer who underwent argon-helium cryoablation.Four groups were divided according to the hockey coverage.The general information of the patients,tumor-related data,intraoperative data and postoperative complications data was collected by the hospitalized medical system search and the record room search,postoperative survival data were collected by outpatient or telephone follow-up,and the data were statistically analyzed to observe the effects of different ablation ranges on postoperative survival and complications in patients with primary lung cancer.[Results]1.Among the 129 patients with non-small cell lung cancer,106 died,and 23 patients survived as of the last follow-up date.The overall median survival was 16.23 months,the 95%confidence interval is[11.96,20.50],and the postoperative median survival was 8.83 months,the 95%confidence interval is[6.77,10.90].2.Single factor analysis:in terms of cold ablation range,the postoperative median survival of patients with hockey coverage<60%is 3.40 months;the postoperative median survival of patients with hockey coverage 60%-79%is 8.37 months;the postoperative median survival of patients with ice hockey coverage of 80%-99%is 13.57 months;the postoperative median survival of patients with hockey coverage ?100%is 12.43 months;it can be seen that the patients with coverage of ice hockey is 80%-99%had longer survi'val than patients with other coverage,with statistical differences(P=0.001<0.05).3.Stratified analysis:patients younger than 65 years old,with the increase in the coverage of ice hockey,the patient's postoperative median survival has increased,the hockey coverage? 100%patients reached the most long,there is a statistical difference(P=0.01<0.05);ages greater than or equal to 65 years old,with the increase of ice hockey coverage,the postoperative median survival of patients increased and then decreased,and the patients with coverage of ice hockey is 80%-99%had longer postoperative median survival,and there was no significant difference(P=0.33>0.05).The clinical stage ? and ? patients showed a first growth and a decreasing trend with the increase of ice hockey coverage.When the hockey coverage rate was 80%-99%,the postoperative median survival time reached the longest,with statistical difference(P=0.002<0.05?P=0.000<0.05);The anatomical structure was central.With the increase of ice hockey coverage,the postoperative median survival of patients decreased and when the hockey coverage rate reached 60%-79%,the median survival time was the longest,with no significant difference(P=0.27>0.05).The postoperative median survival time of patients with peripheral lung cancer was similarly increased and then decreased.The postoperative median survival time of patients with ice hockey coverage of 80%-99%was the longest,and there was statistically significant difference(P=0.000<0.05).The pathological type of adenocarcinoma group had the longest postoperative median survival time with the hockey coverage rate ?100%,and there was statistical difference(P=0.001<0.05).Patients with squamous cell carcinoma with a hockey coverage rate of 60%-79%had the longest postoperative median survival time,with no significant difference(P=0.191>0.05).There was no significant difference in the effect of different ice hockey coverage on postoperative survival at the preoperative lesion size.4.Multi-factor analysis:clinical staging,whether the tumor is close to the visceral pleura,ice hockey coverage,the number of cryoprobe is the independent factors affecting postoperative survival.Among them,compared with stage ?,stage ?,stage ?,and stage ?were protective factors(P=0.79,P=0.02,P=0.002);the tumor was not close to the visceral pleura as a protective factor(P=0.001).Hockey coverage?100%,coverage<60%as risk factor(P=0.02),coverage rate 60%-79%,80%-99%are protective factors(P=0.53,P=0.40).Compared with the use of the cryoprobe 4,the cryoprobe 1,2,and 3 were all protective factors(P=0.004,P=0.02,P=0.05).Taking the survival curve of each covariate in the mean value,we can see that the survival curve of coverage 60%-79%,80%-99%is above the coverage>100%.So compared with patients with hockey coverage of ?100%,patients with hockey coverage of 60%-79%,80%-99%may have longer postoperative survival.5.In terms of safety,the incidence of cough,hemoptysis,pneumothorax,fever,pleural effusion,and periorbital hemorrhage increased with the increase of ice hockey coverage;in terms of surgical site pain,hockey coverage?100%has the lowest incidence,60%-79%highest.[Conclusion]1.Clinical stage,hockey coverage,whether the tumor is close to the visceral pleura,and the number of cryoprobe is independent factors affecting the postoperative survival of the patients.Among them,the clinical stage is early,the number of cryoprobe is small,the tumor is not close to the visceral pleura,and the coverage rate is 60%-79%and 80%-99%patients may have a longer postoperative survival;2.For lung cancer patients younger than 65 years old and adenocarcinoma,the hockey coverage rate>100%has a longer postoperative survival;for clinical stage ? and ?,peripheral lung cancer patients,the hockey coverage rate is 80%—99%have a longer postoperative survival;3.In terms of safety,the hockey coverage rate ?100%group has a higher incidence of complications than the other groups.4.This study suggests that the efficacy of argon-helium cryoablation in lung cancer is affected by the hockey coverage.The basic coverage and ideal coverage should be set during surgery design and operation,which may benefit patients most. |
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