经肺动脉灌注碘油对肺转移瘤的血供研究

Study on blood supply of lung metastasis with trans-pulmonary arterial lipiodol infusion

目的通过肺动脉灌注少量碘油研究肺动脉与肺转移瘤的血供关系。方法10例肺转移瘤患者,其中原发灶为肝癌5例、肾癌3例、脊索瘤1例和恶性神经纤维瘤1例。胸部CT平扫排除钙化;肺动脉插管造影观察有无肿瘤血管和染色。超选到转移瘤所在肺叶动脉造影排除肺动静脉瘘及其他异常交通循环,确定管头位置后严格透视下释放少量碘油,肺叶动脉用量0.5～1.5ml,总量不超过3ml。随即送至CT室平扫,观察碘油沉积情况。结果除1例患者肺动脉注入碘油后出现胸闷咳嗽外,余均无不适症状。共观察27个转移灶,全部病例未见肺动脉增粗或肺动脉肿瘤染色征象,6个结节内碘油积聚呈云雾样,5个肿块内碘油积聚呈散在细小砂粒样,另有16个结节无明显碘油积聚。结论肺动脉部分参与肺转移瘤的供血,对于肺野外带转移灶其供血比例较高;经肺动脉灌注少量碘油是安全的,肺野的密度升高在一段时间后可以恢复正常。

Objectvive To evaluate the blood supply of pulmonary metastases using small volume of lipiodol through pulmonary arterial infusion. Methods 10 cases of lung metastasis were enroled including the primary tumors of liver cancer（n = 5）, renal carcinoma（n = 3）, chordoma（n = 1） and malignant neurofibroma （n = 1）. Plain CT scan was performed to exclude calcification or ossification within metastasis and then pulmonary arterial DSA was undertaken to evaluate tumor vessels or staining. After pulmonary arteriovenous fistula or other anomalous circulation was excluded by lobar arterial DSA, small volume of lipiodol was infused under fluoroscopy （0.5 -1.5 ml for each lobar artery, total volume less than 3.0 ml）. CT scan was immediately performed. Blood supply of the pulmonary metastases was assessed according to the accumulation of lipiodol on CT scans. Results No cases but one experienced cough, expectoration, suffocating or dyspnea. No complication of cerebral or visceral embolism occurred. Totally 27 nodules were studied including 6 nodules with cloudy lipiodol accumulation and 6 nodules with tiny granules of lipiodol accumulation. No enlarged tumor vessel or tumor stain was observed within all 27 nodules on pulmonary arterial DSA. Conclusions Pulmonary artery supplys only parts of pulmonary metastases, especially those sited at the peripheral region of the lung. Infusion of small volume of lipiodol through pulmonary artery is safe, and the increased density of lung field could return normal after several days.