The Clinical Application Of The Argon-Helium Cryoablatoinon Maligant Tumors Under The Guidance With Ultrasonography And CT Imaging

Objective: To observe noumenal malignant tumors of many organ were treated with argon-helium cryoablation under the guidance of ultrasonography and CT imaging and monitoring, approach the clinical applied range and therapeutic efficacy of the argon helium cryoablation.Methods: 45 patients with 49 foci of malignant tumors were treated with argon-helium cryoablation under the guidance of ultrasonography and CT imaging from Oct 2004 to March 2006.All the patients, aged 38-78 years old, male 25 cases, female 20 cases, who were not suitable to surgical resection or were reluctant to be taken the operation. The diagnosis were confirmed by histopathology, the formation and size and diversity of ice-balls were monitored and recorded , The diameters on transverse and longitudinal sections were measured and recored at 5 minutes,10minutes, 15minutes. The temperature of cryoablated area were monitored and recorded. Pathological sections were analyzed pre-cryotherapy and post-cryotherapy instantly and post-cryotherapy 2 weeks. The complications occured during cryoablation were recorded and treated ,The foci of malignant tumors were divided into≤3cm and＞3cm groups in size. The ice-ball and its coverage and the shrinkage of tumor were observed post cryoablation. All data were analyzed by SPSS11.0 software. Numeration data were analyzed by chi-square test, measurement data express mean±standard deviation, p＜0.05 showed statistical significance, p＜0.01 showed more statistical significance.Results :The temperature in operating field decreased fast to -130℃--150℃in a minute and maintained -150℃or so. The temperature in operating field rose to 15℃in a minute after rewarming. The ice-balls were demonstrated within 50 seconds after cryoablation in 87.5% cases. And the arc and angled arc hyperechogenity with shadow were sonographically showed on the trans- and longitudinal cryoablation section respectively. With the temperature went up, the arc hyperechogenicity with shadow became weak gradually to disappear. As the result, the inhomogeneous echogenity were seen in the cryoablated area. The round low density area were seen in cryoablated area on the CT imaging. The diameters on transverse and longitudinal sections measured showed changes at 5minutes ,10minutes, 15minutes. The data increased significantly in longitudinal diameters from 10 to 15minutes.The various changes were histopathologically seen, such as the loose cytoplasm, vacuole degeneration, pyknosis, karyorrhexis, karyolysis, ect, post-cryotherapy instant and nucelus vanished post-cryotherapy 2 weeks, uniformity eosin staining were histopathologically seen. With the guiding of ultrasound, 2 cases occured bleeding in liver- kidney diastema . 2 cases occured hemorrhage liver capsule, incidence rate was 22.2%, 1 case occured low echo-level bile leak, with the guiding of CT, 4 cases occured pneumothorax, incidence rate was 23.5%. No serious complication occurred.The ice-ball coverage rate≥80% was 72.7% and the ice-ball coverage rate＜80% was 27.3% in the group of diameter≤3cm .The ice-ball coverage rate≥80%and＜80% was 26.3%,73.7% in the group of diameter＞3cm respectively. The ice-ball coverage was significantly different between the two groups(P＜0.05 ). The shrinkage of the cryoablated lesions≥50% was 81.8%和30.6% in the the group of diameter≤3cm and＞3cm respectively, the shrinkage of the cryoablated lesions was more significantly different (P＜0.01).Conclusion(1) It was safe that the cryoablated treatment on malignant tumors under the guidance of ultrasound or CT, the applied range was extensive, localization was accurate, achievement ratio of puncturation was 100%.(2) The Changes of imageology were characteristic ,The data increased obviously in longitudinal diameters from 10 to 15minutes,which forecasted boundary of the ice-ball, guided needle scheme so as to destroyed tumor utmostly.(3) The guidance and instant monitor with ultrasound in liver were simple and convenient, were easier to monitor complication. The guidance with CT was safer than with ultrasound in Lung, which not only can find therapeutic range and adjoining relation promptly, but also find complication such as pneumothorax, but localization was time-consuming, can not continuous monitor instantly.(4) The argon-helium cryoablation was effective, especially for the patients with the malignant tumors in early stage.