经支气管动脉内治疗肺癌时预防脊髓损伤的研究

Prevention of Spinal Cord Injury during Intra-broncho-arterial Treatment of Pulmonary Cancer

目的 为了总结经支气管动脉内治疗肺癌时,预防脊髓损伤的经验。方法 根据血流动力学的特点,在经支气管动脉内治疗肺癌时,将导管末端置于支气管动脉开口前一血液自然灌注小区内,间断地推注药物,从而避免了药液返流。结果 全组302例肺癌患者中26例采用将导管插进支气管动脉中的常规方法治疗,术后4例发生脊髓损伤,发生率为1.3％,其中3例高位截瘫,1例右下肢单瘫;而采用根据血流动力学特点改进的方法治疗的276例病人,术后无1例发生脊髓损伤。结论 根据血流动力学特点改进的血管内治疗肺癌的方法,从根本上改变和替代了常规将导管直接插进支气管动脉内的方法。临床实践证明,该方法是一种全新的可避免脊髓损伤的有效方法。

Objectives To summarize the experience in prevention of the spinal cord injury during intra-broncho-arterial treatment of pulmonary cancer. Methods The conventional method of intra-broncho-arterial treatment for pulmonary cancer was improved according to the hemodynamics characteristics. The antitumor drugs were delivered intermitltently into the blood flow through a catheter, of which terminal had been placed in a region before the open of the bronchial artery. Of 302 patients with pulmonary cancers, 276 were treated by this improved endovascular method and 26 by the conventional endovascular method. Results Among the 276 cases treated with the improved method, no patient underwent spinal cord injury, while in 26 cases treated by the conventional method, spinal cord injuries occurred in 4 cases, including the 3 patients with high level paraplegia, and one with right lower limb paralysis. Conclusions The clinical study demonstrated to the improved method of endovascular treatment of pulmonary cancer is an effective way to avoid spinal cord injury.