同轴导管超选择支气管动脉碘油化疗栓塞治疗肺癌的初步研究

Co-axial Super-selective Bronchial Arterial Chemoembolization for the Treatment of Bronchogenic Carcinoma

目的 探讨经微导管行超选择性支气管动脉碘油化疗栓塞治疗肺癌的可行性 ,观察碘油在癌灶内的沉积情况及临床疗效。资料与方法 用同轴导管技术将微导管超选择插至 17例肺癌患者 (男 13例 ,女 4例 ,年龄 41～78岁 ,平均 5 9.5岁 )的支气管动脉深部 ,插管成功者采用碘油化疗栓塞治疗 ,并于术后 1天、1周、4周行CT复查 ,观察碘油在瘤体内的沉积情况。插管未成功者仅行灌注化疗。结果 超选择插管成功 13例 (76 .5 % ) ,术后 1天碘油沉积 0级 1例 ,Ⅰ级 3例 ,Ⅱ级 7例 ,Ⅲ级 2例。碘油在肺癌组织内沉积多可持续 4周以上。治疗后 4周有 8例肿瘤缩小 5 0 %以上 ,4例缩小 2 5 %～ 5 0 % ,1例大小无明显变化。均未出现与栓塞有关的并发症。结论 采用微导管同轴导管系统行超选择性支气管动脉碘油化疗栓塞治疗肺癌是一种安全有效的治疗方法 ,在临床上具有可行性。

Objective To investigate the feasibility of co-axial super-selective bronchial arterial catheterization, and to assess the effectiveness of bronchial arterial chemoembolization for the treatment of pulmonary carcinoma.Materials and Methods Tumor-feeding arteries, mainly the bronchial arteries, in 17 patients with advanced bronchogenic carcinoma were successfully co-axially catheterized with microcatheters. Bronchial arterial infusion (BAI) and bronchial arterial embolization (BAE) were performed by slowly infusing atni-neoplastic agents and a suspension of atni-neoplastic agents mixed with Lipiodol. The retention of Lipiodol within the tumor after the procedure was observed with CT.Results Within 24 hours after embolization, on CT scans Lipiodol retention grade 0, Ⅰ, Ⅱ and Ⅲ was seen in 1, 3, 7 and 2 cases, respectively. In most tumors, Lipiodol remained within the lesion for more than 4 weeks. The response rate was 61.5% (PR). No severe complications, including injuries of spinal cord, esophagus, intercostal artery and bronchial mucous membrane, occurred during the whole course.Conclusion Co-axial super-selective bronchial arterial catheterization is clinically feasible, and BAE with this technique is a safe and effective therapy for bronchogenic carcinoma.