肺隔离高温药物灌注治疗肺癌(附14例报告)

Isolated Hyperthermic Lung Perfusion with Chemotherapeutic Agents in the Treatment of Unresectable Lung Cancer

游离阻断１４例中、晚期肺癌病人的单侧肺（或肺叶）主要血管，经肺动脉、肺静脉插管与心泵连接，建立与体循环隔离的体外肺循环。在肝素化预充液中加入超量表阿霉素和环磷酰胺，进行高温（４１～４３℃）灌注５０～６０分钟，停机关胸。本组无手术死亡。术后１、２年分别死亡２、５例，生存率分别为８５．７％和５０％，余７例均健在。术后１０～１２个月对肺部残存肿块在ＣＴ定向下穿刺活检均为纤维组织。证明此疗法杀灭肿瘤组织效果确切。

Aim:To review the experience of isolated hyperthermic lung perfusion with chemotherapeutic agents in the treatment of unresectable lung cancer.Clinical material and method:14 patients with late stage lung cancer underwent isolated hyperthermic lung perfusion with chemotherapeutic agents.A perfusion catheter was inserted in the pulmonary artery,a venous drainage cannula was placed in the pulmonary vein,and both catheters were connected to the heart pump.The lung or lobe was totally isolated and then perfused with adriamycin(7～8μg/ml)and cyclophosphamide(0.2～0.3mg/ml)under hyperthermia of 41～42℃ for 50～60 minutes.Result:There were no hospital deaths.The complications included hypovolemic shock and acute pulmonary edema.The mean hospital stay was 11.5 days(range,9～13 days).During follow up of 18 to 26 months,one patient developed bone metastases.The 1 year and 2 year survival rates were 85.3% and 50%,respectively.After treatment,complete improvement was achieved in 3 patients and partial improvement in 11 patients.Conclusion:Isolated hyperthermic lung perfusion with chemotherapeutic agents is a safe and effective method for the treatment of late lung cancers,particularly for those unresectable tumors.Injuries to the hyperthermically perfused lungs was slight and reversible.