DSA与MSCTA在肺癌介入治疗中的协同应用研究

Synergistic effect of DSA and MSCTA in interventional therapy for lung cancer

目的探讨DSA与MSCTA在肺癌介入治疗中协同应用的价值。方法肺癌介入治疗患者46例,术前均行MSCT平扫加增强。其中,26例术前通过容积显示(VR)、最大密度投影(MIP)、多平面重建(MPR)等三维重组技术完成肺癌供血动脉MSCTA后行DSA造影及介入治疗,即为CTA组。20例未行MSCTA重组,即为无CTA组。对两组术中查找肿瘤供血动脉数量、选用导管数量、对比剂用量、减影采集序列次数、透视时间及手术时间等结果进行评价分析。结果全组46例均插管成功,并完成介入治疗。CTA组术中DSA造影显示供血动脉情况与MSCTA显示一致。两组术中在查找供血动脉数量差异无统计学意义(P>0.05),但在选用导管数量、对比剂用量、减影采集次数、透视时间及手术时间等差异有统计学意义(P<0.05),且CTA组均少于无CTA组。而对支气管动脉变异、多支动脉及肺外体循环动脉参与供血的显示,CTA组优于无CTA组。CTA组未出现严重并发症而无CTA组中1例术后出现"脊前动脉综合征"。结论DSA与MSCTA在肺癌介入治疗中的协同应用是较合理、可行的操作方案,术前常规行MSCTA有利于降低术中操作难度、减少并发症,有助于提高肺癌介入疗效。

Objective To evaluate the synergistic effect of DSA and MSCTA in interventional therapy for lung cancer. Methods Interventional therapy was performed in 46 patients with lung cancer. With real time helical thin slice CT scanning, MSCTA of tumor feeding artery was performed in 26 patients. Images obtained from enhanced MSCT scanning were processed at the console workstation. Spatial anatomical characteristics of tumor feeding artery were observed by using different rotations of view. DSA study and the interventional therapy were followed up in 26 patients with lung cancer. Results All tumor feeding arteries in 26 patients with lung cancer were observed by using VR, MIP and MPR, which could exactly display the origin, course and diameter of the vessels. DSA had a high consistency with MSCTA in displaying the tumor vascularity, tumor stain, and the origin of tumor-feeding artery in the patients who received MSCTA and the interventional therapy. The number of catheter used, the dosage of contrast medium, the sequence of subtraction, the fluoroscopic time and operation time in the group with use of CTA was less than that in the group without use of CTA, and the difference between two groups was statistically significant （P 〈 0.05）, while no significant difference in detecting feeding artery existed between two groups （P 〉 0.05）. Conclusion The anatomical characteristics of tumor-feeding artery in patients with lung cancer can be stereoscopically and clearly displayed on preoperative routine MSCTA, providing useful information and thus making the interventional procedure more safe and effective. Simultaneous use of DSA and MSCTA is reasonable and practicable, which has synergistic effect in interventional therapy for lung cancer.