摘要
目的 研究肺癌支气管动脉血管重塑的特征与患者预后的关系。方法 据国际肺癌分期标准,16例Ⅲa期,42例Ⅲb期肺癌患者在支气管动脉灌注化疗前做了支气管动脉造影。血管造影片由放射科医师阅读,并由真彩色图像分析系统处理。随访患者,收集资料。结果 支气管动脉造影血管的共同特征是不同程度扩张、过度增生交织呈网状,造影剂漏出,肿瘤区有不同程度的染色。特殊的征象是有30例癌周血管呈放射状生长,包括20例小细胞肺癌(66.7％),7例腺癌(23.3％),3例鳞癌(10.0％);另一个特征,16例癌周有一粗大环行的血管;5例具有上述两种特征。随访中,癌周有血管呈放射状生长的患者中,19例发现有血行转移(63.3％),3例锁骨上淋巴转移(10.0％);2例治愈性切除后6个月、30个月局部复发(6.7％)。而癌周无血管呈放射性生长的28例患者中,仅2例发现血行转移。血行转移率两组中有显著的差异(P<0.01)。结论 肺癌支气管动脉造影重塑癌周血管呈放射性的生长是癌血、淋巴高转移率的重要征象。
Objective: To study vascular characteristics of bronchial arterial reconstruction for lung cancer in relation to patient’s prognosis.Methods: According to the International Staging System for Lung Cancer, bronchial arteriography was performed in 16 patients with stage III a , 42 patients with stage III b lung cancer before bronchial arterial infusion (BAI) of chemotherapy. Angiograms was read by radiologists and analyzed by real-multicolour picture system. All patients were followed up and the data were collected.Results: The common findings of angiographic vessels were variable distending, hypervascularity with shunting as net, and extravasation of contrast, light or dense staining in the regions of the tumors for all patients. Radial growth vessels in pericancer were found in 30 patients, including 20 cases (66.7%) of small cell lung cancer (SCLC), 7 cases (23.3%) of adenocarcinoma, 3 cases (10%) of squamous carcinoma; a thick circular vessels in pericancer in 16 patients: both characteristics above were seen in 5 cases. Hematogenous dissemination was found in 19 of 30 patients (63.3%) with radial growth vessels in pericancer; lymphatic spread (supraclavicular nodes) in 3 of 30 (10%); local recurrences in 2 of 30 (6.7%) 6 and 30 months respectively after curable resection. Hematogenous dissemination was found in 2 of 28 patients (7.1%) without radial growth vessels in pericancer during the period of follow-up. There was significant difference in the rate of hematogenous dissemination in two groups (P<0.01).Conclusion: Radial growth vessels at pericancer for bronchial arteriography of lung cancer was an important sign of high rate of hematogenous dissemination and lymphatic spread.
Key words lung cancer - angiography - metastasis
