支气管肺癌介入治疗的临床研究

Interventional Therapy of Bronchogenic Carcinomas: A Clinical Study

目的 探讨经皮支气管动脉灌注化疗和灌注化疗栓塞治疗中晚期肺癌的临床效果。资料与方法 对 5 7例肺癌患者施行了经皮支气管动脉灌注化疗或灌注化疗栓塞术。采用改良式Seldinger技术 ,行选择性和超选择性支气管动脉插管。经导管注入超液化碘油 (3～ 10ml)和吡柔比星 (10mg)的混悬液 ,然后注入另外 2种化疗药物 ,咳血患者最后用明胶海绵颗粒适量栓塞肿瘤周围小血管 ,支气管动脉主干保持通畅。结果 40例为富血管型(70 .18% ) ,17例 (2 9.82 % )为乏血管型。现存 15例中 ,半年生存率 10 0 % ,1年生存率 80 .0 0 %。死亡 33例 ,中位生存期 14.75个月 ,半年生存率 96 .97% ,1年生存率 73.33% ,2年生存率 33.81% ,3年生存率 9.0 9%。结论 经皮支气管动脉灌注化疗栓塞 ,三明治方法是治疗中晚期肺癌的最有效方法之一。可以确切延长中位生存期 ,提高患者生存质量。长期疗效需要大量随机增加病例及长期随访 。

Objective To study the therapeutic effect of bronchial arterial infusion (BAI) and bronchial arterial chemoembolization (BACE) on advanced bronchogenic carcinomas.Materials and Methods Using modified Seldinger's technique and super-selective catheterization, BAI or BACE was performed in 57 patients with lung cancer. A suspension of Lipiodol-altrafluid (3～10ml) mixed with Pirarubicin (10mg) was infused via the catheter, followed by the infusion of two anti-neoplastic agents. Gelfoam particle was used in the patients with hemoptysis to embolize small vessels around the tumor while keeping the main stem of the bronchial artery patent. The above procedure was so-called 'sandwich method'.Results On BAG, the lesions were hypervascular in 40 cases (70.18%), and hypovascular in 17 (29.82%). The right intercostobronchial trunk was found in 54.29% (19/35). Of the 15 cases still alive when the study was reported, the survival rate at 6 and 12 months was 100% and 80%, respectively. Thirty-three died with a median survival period of 14.75 months, of which the survival rate at 5, 12, 24 and 36 months was 96.97%, 73.33%, 33.81% and 9.09%, respectively. The living quality was significantly improved in most patients.Conclusion BAI and BACE with sandwich method is one of the most effective therapies for the treatment of advanced lung cancer. The interventional therapy can prolong patient's life and improve the living quality. Long-term follow-up of a large number is needed to assess the real clinical effectiveness of BAI and BACE.