经微导管碘化油化疗药乳剂栓塞治疗原发性富血型非小细胞肺癌41例分析

Analysis of 41 Cases of Primary Hypervascular Non-small Cell Lung Cancer Treated with Embolization of Emulsion of Chemotherapeutics and Iodized Oil

背景与目的动脉内化疗、栓塞是治疗肺癌的主要手段,但多数报道并未将小细胞肺癌与非小细胞肺癌、乏血型肺癌与富血型肺癌区分开来做进一步研究,栓塞前的化疗药灌注一直延用,对碘化油栓塞报道很少。本文通过对患者治疗后生存质量、临床有效率、生存期以及并发症进行总结,旨在探讨碘化油化疗药乳剂栓塞治疗原发性富血型非小细胞肺癌的临床疗效。方法2008年1月-2009年1月经病理证实并完成随访的患者41例,CT增强扫描病灶中等度以上强化,提示血供丰富。包括中央型23例,周围型18例,鳞癌21例,腺癌15例,腺鳞癌5例;IIIb期34例,IV期7例。使用微导管在DSA下做靶动脉超选择插管,以液态碘化油+表阿霉素乳剂栓塞肿瘤毛细血管床,以明胶海绵微粒栓塞肿瘤供血动脉,液态碘化油用量5mL-10mL,表阿霉素10mg-30mg。最长随访12个月并与2007年-2009年相关文献进行对比。结果治疗后患者症状改善,KPS显著提高(P<0.05),局部病灶完全缓解(complete response,CR)0例,部分缓解(partial response,PR)31例,无变化(no change,NC)7例,疾病进展(pro-gressive disease,PD)3例,总有效率(CR+PR)75.60%,临床受益率(CR+PR+NC)92.68%。总生存期超过12个月者33例(80.48%),IIIb期29/34(85.29%),IV期4/7(57.14%)。并发症脊髓损伤1例。结论碘化油+化疗药乳剂单纯栓塞治疗原发性富血型非小细胞肺癌临床疗效肯定,同时避免化疗药毒副反应。DSA下使用微导管做绝对的超选择插管并仔细区分脊髓动脉以及肿瘤内动静脉瘘是避免脊髓损伤等严重并发症的关键。

Background and objective Transcatheter arterial chemotherapy and embolization is the main method in the treatment of lung cancer, but most of the reports do not study individually to small cell lung cancer （SCLC）, non-small cell lung cancer （NSCLC）, hypovascular and hypervascular lung cancer. The pre-embolization perfusion of hemotherapeutics is still being used routinely and seldom report to iodized oil embolization. The article summarized the quality of life after the treatment, clinical efficiency, survival time and complications to evaluate the clinical effect of primary hypervascular NSCLC treated with embolization of emulsion of chemotherapeutics and iodized oil. Methods The study totally analyzed 41 cases which confirmed by pathology and follow up study from January, 2008 to January 2009. The CT scan with IV contrast demonstrates over moderate enhanced lesion which indicate hypervascular. Within the 41 cases, 23 cases of central, 18 cases of peripheral. Suqamous carcinoma 21 cases, adenocarcinoma 15 cases and squamoadenocarcinoma 5 cases. Stage IIIb 34 cases, stage IV 7 cases. Superselective incubation with microcatheter under DSA, to embolize the capillary bed with liquefied iodized oil and the emulsion of pharmorubicin, to embolize the supply artery of the tumor with gelatin foam microparticle. The liquefied iodized oil 5 mL-10 mL, pharmorubicin 10 mg-30 mg. The longest follow up is 12 months and to compare with the references of 2007-2009. Results The KPS is widely acclaimed after the treatment （P0.05）, no complete response （CR）, 31 cases of partial response （PR）, 7 cases of no change （NC） and 3 cases of progressive disease （PD）, the total efficiency （CR＋PR） is 75.6%. The clinical efficiency （CR＋PR＋NC） is 92.68%. 33 cases of total survival tome over 12 months （80.48%）, IIIb stage 29/34 （85.29%）, IV stage 4/7 （57.14%）. 1 case with severe complication-spinal injury. Conclusion To treat primary hypervascular NSCLC with simple embolization of emulsion of chemotherapeutics and iodized oil is very useful and can avoid the side effect of chemotherapeutics. The key point to avoid spinal injury and other severe complications is to distinguish the spinal aretery and intratumor AV fistula by using superselective incubation with microcatheter under DSA.