血脑屏障开放后动脉介入化疗对肺癌脑转移患者的临床疗效研究

The clinical research of artery interventional chemotherapy for brain metastases of lung cancer after opening blood-brain barrier

目的探讨血脑屏障开放后超选择性颅内动脉介入化疗的临床疗效。方法将90例确诊肺癌脑转移患者随机分为三组,分别为甘露醇导管化疗组、导管化疗组和全脑放疗组。甘露醇导管化疗组用股动脉插管技术超选择性的向肿瘤供养动脉后分别依次灌注20%甘露醇、卡铂和吉西他滨化疗药物;导管化疗组仅依次灌注卡铂和吉西他滨;治疗1个月后与全脑放疗组根据疗效判断标准比较三组的疗效,并通过电话随访判断比较三组的生存率。结果在改善患者预后方面甘露醇导管化疗组总有效率为80.00%,明显高于导管化疗组的50.00%和全脑化疗组的16.67%。三者间的差异有统计学意义(P<0.05)。三组生存率比较示甘露醇导管化疗组的1年生存率、2年生存率、3年生存率分别为56.67%、23.33%、6.67%,与导管化疗组和全脑放疗组比较差异有统计学意义(P<0.05)。三组中位生存期比较差异有统计学意义(P<0.05)。结论应用甘露醇开放血脑屏障后颅内动脉灌注化疗药物治疗肺癌脑转移患者的方法操作简单、并发症少,药物可经导管直接进入肿瘤供养动脉,迅速杀死肿瘤细胞,值得临床推广。

Objective To investigate the clinical efficacy of the interventional chemotherapy in super-selective intracranial artery after the opening blood-brain barrier. Methods Ninety confirmed lung cancer patients with brain metastases were randomly divided into three groups ： mannitol catheter chemotherapy group, catheter chemotherapy group and whole brain radiotherapy group. In the mannitol chemotherapy group,20% mannitol, carboplatin and gemcitabine chemotherapy were respectively infused into the super-selective tumor support arteries with catheter tech- nique with femoral artery. In catheter chemotherapy group, carboplatin and gemeitabine were infused. One month after the treatment the efficacy were compared between three groups according to the efficacy judging criteria. The survival rate between three groups was compared by telephone follow-up survey. Results The total effective rate of the mannitol catheter chemotherapy group in the improvement of prognosis was 80. 00% which was higher than the 50. 00% of the catheter chemotherapy and the 16. 67% of the whole brain chemotherapy group. There was statistically significant difference between three groups （ P 〈 0. 05 ）. One -year survival rate, two-year survival rate, and three-year survival rate in mannitol catheter chemotherapy group were 56. 67%, 23.33%, 6. 67% respectively. The differences between the three groups was statistically significant （ P 〈 0. 05 ）. There was statistically significant difference in the median survival time between the three groups （ P 〈 0. 05 ）. Conclusion Mannitol catheter chemotherapy for brain metastatic tumor of lung cancer after the opening of blood-brain barrieer has advantage of simple operation and less complications. During the treatment,chemical drugs can arrive at the tumor supportive arteries directly and kill the tumor cells rapidly,which was worthy of popularization.