肺癌血管构型与支气管动脉灌注疗效的关系

目的：探讨原发性肺癌的血管构型及以气管动脉灌注疗效的关系。方法：采用Seldinger技术,对42例原发性肺癌行选择性支气管动脉造影（SBAG）并向支气管动脉内灌注化疗药物。随后观察疗效。结果：多血管型肺癌占61．9％（26／42）,少血管型肺癌35．7％（15／42）,无血管型占2．4％（1／24）,达完全或部分缓解者,多血管型20例,少血管型7型,无血管型治疗无效,结论：对肺癌选择性支气管动脉造影征象的研究,是提高BAI疗效的重要手段之一。     

Intraarterial infusion of low-dose streptokinase after acute thromboembolization of the right renal artery

Acute arterial thromboembolization is a well-recognized complication following myocardial infarction. Intraarterial infusion of thrombolytic agents is a relatively new method of treating such thromboembolic occurrences. We describe a patient who was successfully treated with low-dose, intraarterial streptokinase infusion following occlusion of the right renal artery 1 week after an acute myocardial infarction.     

Transcatheter thrombolysis in cancer patients

Arterial thrombolysis was successfully accomplished in 15 of 18 (83%) cancer patients by the continuous intraarterial transcatheter administration of streptokinase (70 units/kg/h or 5000 u/h and/or urokinase (400–500 u/kg/h) over 24–96 h. In 16 of these patients, the arterial thrombosis was a complication of transcatheter infusion of chemo-therapeutic agents or embolization therapy. A combination of streptokinase, urokinase and heparin (10,000–25,000 U/day) was utilized without significant side effect and was effective in all 8 patients receiving treatment. Creating a tunnel through the clot, daily monitoring of the catheter with repositioning when necessary, and adjusting the type and dose of thrombolytic agent aided the therapeutic management.     

Intraarterial infusion chemotherapy with lipioclol-CDDP suspension for hepatocellular carcinoma

Purpose: To quantitatively evaluate the usefulness of lipiodol-CDDP suspension (LCS) chemotherapy in hepatocellular carcinoma (HCC). Methods: CDDP (cis-diamminedichloroplatinum) powder was prepared by removing the water and NaCl from aqueous CDDP. Two quantities of prepared CDDP powder, 10 mg and 20 mg, were mixed with 1 ml each of iopamidol 300 mgI/ml (IP300) and lipiodol (LPD) using a high pressure pumping method, thus producing LCS. Thirty-two patients with HCC, who had good renal function [creatinine clearance (Ccr) 50 ml/min or more], received additional intraarterial infusion chemotherapy with LCS or LCS alone. Results: The most frequently observed CDDP powder sizes were 5.95–10.90 μm (average: 11.59 μm). The LCS obtained demonstrated a suspension of 2–12 μm (average 3.69 μm) immediately after mixing, and no significant changes were observed in LCS particle sizes 3 hr after mixing. Moreover, the sustained release with LCS was observed for up to 3 hr. Meanwhile, the peripheral free platinum concentration between intraarterial infusion chemotherapy with LCS and intraarterial infusion with the aqueous solution of CDDP, with respect to variance residence time (VRT), showed a significant difference, with a p value of 0.0382. The survival rate was 89.84% at 1 year, 73.78% at 2 years, and 68.51% at 3 years. Furthermore, the platinum concentration in the tumor was 25–95 times the concentration in the surrounding liver parenchyma. Conclusion: Good clinical results can be expected by applying LCS to HCC.     

肺癌支气管动脉化疗栓塞术的疗效分析

目的 评价支管动脉化疗栓塞术的治疗效果。方法 对38例支气管肺癌患采用Seldinger技术，一般行右股动脉穿刺插管，运用5F Cobra导管行支气管动脉造影。并用牧羊钩导管及3．0F SP导管同轴超选择插管，行支气管动咏灌注化疗栓塞。结果 化疗栓塞术后一个月复查胸片及CT，肿瘤阴影缩小90％以上2例。肿瘤阴影缩小50％以上11例，肿瘤阴影缩小低于50％19例。病灶稳定6例，病灶进展0例。结论 支气管肺癌行支气管动脉化疗栓塞术是一种难度较大但效果较好的介入治疗方法之一，只要选择导管得当，操作上耐心细致，大多数是可以成功的。     

支气管动脉栓塞治疗大咯血

目的：探讨支气管动脉栓塞(BAE)治疗大咯血的临床应用价值。方法：57例大咯血患者支气管动脉插管造影明确病变血管后，经导管缓慢注入明胶海绵颗粒栓塞出血血管，18例患者使用微导管超选择性BAE治疗。结果：出血完全停止44例，出血量减少9例，无效4例，有效率92．9％。结论：支气管动脉栓塞治疗大咯血是一种安全、有效、操作简便、损伤小的治疗方法。     

低剂量丝裂霉素C对实验性肿瘤放疗疗效的影响

目的 探讨低剂量丝裂霉素C（MMC）辅助放疗的可能性。方法 大体测量荷瘤小鼠肿瘤变化,并用放免分析方法测定小鼠免疫功能。结果 预先使用低剂量MMC使肿瘤缩小幅度较单纯放疗明显。放疗前12h给予低剂量MMC,免疫功能明显高于单纯放疗组（P＜0．05）,并接近单纯荷瘤组。结论 预先使用低剂量MMC可提高放疗疗效,并且明显改善放疗引起的荷瘤机体免疫功能低下。其机理可能与荷瘤机体免疫力的提高,并诱导机体产生的适应性反应有关。     

坚守肺癌介入治疗的阵地

肺癌是发病率最高的恶性肿瘤,我国的介入治疗是从支气管动脉灌注(BAI)治疗肺癌开始的,肺癌的BAI曾经占介入科临床工作相当比重,但近年来逐渐减少,本文分析了原因和对策。     

支气管动脉碘化油化疗栓塞肺癌

目的 探讨支气管动脉碘化油化疗栓塞治疗肺癌的可行性和疗效.方法 化疗栓塞33例肺癌,其中鳞癌20例,腺癌8例,小细胞癌1例,未定型4例;Ⅱ期5例,ⅢA期13例,ⅢB期11例,Ⅳ期4例.行支气管动脉插管,经导管灌入CDDP 80～100 mg、MMC 10 mg后,再将ADM 30 mg和2～10 ml碘化油(平均4.65 ml)混悬剂化疗栓塞.另外3例化疗栓塞后1周手术切除肿瘤.结果 化疗栓塞组CR2例,PR 21例,S 9例,P 1例,有效率(CR PR)69.7%.化疗栓塞后手术病理见肿瘤细胞大量坏死.未出现脊髓损伤等严重并发症.结论 本法治疗肺癌近期疗效较好,在良好的支气管动脉数字减影血管造影基础上谨慎进行.     

Bronchial artery infusion of mitomycin-C in advanced bronchogenic carcinoma.

Bronchial angiography was performed in 17 patients with advanced non-oat cell bronchogenic carcinoma. The patients were treated 1 to 5 times with infusions of 10 mg of mitomycin-C (MMC) into the tumor-feeding bronchial artery. All but 2 patients received in addition small doses of vincristine (intravenously) and bleomycin (intramuscularly) or only bleomycin to potentiate the effect of MMC. No major side effects occurred and the systemic toxicity was insignificant. An objective tumor reponse was encountered in 11/17 patients. Intraarterial chemotherapy is strictly local and therefore effective especially in patients with limited or locally advanced disease. In patients with more extensive disease an adjunctive therapy of a more regional or systemic modality must be given.     

术前介入化疗在子宫内膜癌的应用及对手术的影响

目的 探讨术前持续子宫动脉灌注化疗在子宫内膜癌治疗中的应用及其对随后手术的影响。方法 在DSA下超选择与肿瘤血管染色占优势侧的子宫动脉,持续动脉滴注顺铂100mg和阿霉素50mg5d,拔管后3－4周手术。选择化疗后手术的子宫内膜癌患者20例为NAC组,随机选择同期直接手术的40例作为对照,比较术中,术后情况。结果 术前化疗组20例中完全缓解率为5．0％,总反应率为60．0％,两组患者术中出血量、手术时间、术后膀胱肠道功能恢复和创口愈合情况均无差异。NAC组浸润肌层外1／2的例数和淋巴结转移率均低于对照组（P＜0．05）。结论 术前子宫动脉化疗可缩小肿块体积,消除亚临床转移,但并不增加随后手术的并发症。     

Prognostic factors in the treatment of non-small-cell lung carcinoma (NSCLC)

From 1980 to 1990 we treated 107 non-small-cell lung carcinomas (NSCLC) with radiotherapy alone. The study was done to evaluate the prognostic factors in an absolutely negative selected group of patients with regard to the International Union Against Cancer (UICC) classification published in 1987. Patients who had a prior response to neo-adjuvant chemotherapy were excluded from the analysis. Therefore, a negative selection of 98 males and 9 females were treated. All patients were classified retrospectively according to UICC 1987. Nine males and 7 females were stages I and II, respectively. In stage IIIa there were 41 patients, and in stage IIIb 42. A total of 18 patients were staged IV. Results: 5-year overall actuarial survival was approximately 1 %. As main prognostic factor we found the stage of disease. Two-year survival rates in stages I and II were 25 %, in stage IIIa 20 %, in stage IIIb 12 % and in stage IV 0%. The Karnowsky Index (KI) was an important second factor: Patients with a good KI (90–100 %) had a 2-year survival rate of 27 %, and patients with a KI of 70–80 % had a 6.5 % 2-year survival rate. Other prognostic factors were: (1) given total radiation dose, (2) actual response to radiation therapy and (3) normal white blood cell (WBC) count. Leukocytosis is a negative factor for prognosis. We conclude that the stage and, among other factors, the general condition (KI, WBC), are relevant for the prognosis of patients with NSCLC. Correspondence to: M. Busch     

术前多层螺旋CT血管造影对肺癌支气管动脉灌注化疗的作用

目的 探讨多层螺旋CT血管造影(CTA)对肺癌支气管动脉灌注化疗的作用.方法 回顾性分析61例经病理证实的原发性肺癌患者的影像学资料,28例患者(CTA组)支气管动脉灌注化疗前均进行多层螺旋CT胸部增强扫描,分别采用容积显示(VR)、最大密度投影(MIP)、多平面重建(MPR)等方法进行后重建处理,观察分析支气管动脉形态特征以指导手术操作,33例患者(无CTA组)支气管动脉灌注化疗前未行多层螺旋CT增强检查;比较2组患者术中对比剂用量、术中所用透视时间、手术所用时间的差异.结果 CTA组28例患者中24例术前明确肺癌供血动脉的起源、开口、走行及分布,与数字减影血管造影技术(DSA)造影显示的肿瘤供血动脉的来源分布基本一致,符合率100％; CTA组平均对比剂用量(44±7) mL,平均透视时间(12.3±2.2)min、平均手术时间为(42±11)min;而无CTA组3项数值分别为(74±21)mL、(26.6±5.3)min、(56±10)min.2组患者术中对比剂用量、术中所用透视时间、手术所用时间均有统计学意义(P＜0.01),且CTA组明显小于无CTA组.结论 CTA术前能明确支气管动脉等供血动脉解剖,术中明显缩短供血动脉的查找时间,从而减少手术时间、透视时间,减少术中对比剂用量和医患的辐射.CTA对肺癌支气管动脉灌注化疗有指导意义.     

支气管动脉间歇性重复栓塞术治疗大咯血

目的分析支气管动脉间歇性重复栓塞术治疗大咯血的疗效。材料和方法报道支气管动脉间歇性重复栓塞术治疗大咯血３２例,共栓塞病变血管５５支,随访６～３４个月。结果近远期疗效分别达９６．９％和９６．７％,咯血复发率仅为３．１％和６．６％。结论此法能有效控制咯血,明显降低复发率。     

支气管动脉灌注化疗及栓塞术在肺癌综合治疗中的作用

目的探讨支气管动脉灌注化疗及栓塞术在肺癌综合治疗中的作用。 方法对78例病理确诊为肺癌的患者,行经支气管动脉灌注化疗及栓塞术,术后根据具体情况再选择手术、化学消融及射频消融、放疗等综合治疗。 结果78例患者中,支气管动脉灌注化疗及栓塞术后,有9例进行了手术切除,9例进行了射频消融,36例进行了放疗;放疗后复发再次行支气管动脉灌注化疗及栓塞术15例,单纯灌注化疗栓塞9例。 结论肺癌的治疗应采取综合治疗手段,需要综合分析,确立个体化的治疗方案,以最有利于患者为出发点,支气管动脉灌注化疗及栓塞术在肺癌综合治疗中起到很重要的作用,为手术切除、放疗、化学消融及射频消融等治疗手段提供了机会和可能。     

支气管动脉栓塞术治疗大咯血26例分析

目的：评价支气管动脉栓塞术治疗大咯血的临床疗效。方法：26例大咯血患者，咯血量300～1200ml／24h，平均420ml／24h，其中肺癌12例，支气管扩张6例，肺结核2例，肺棘球蚴病1例，肺血管畸形5例。采用改良Seldinger方法行选择性支气管动脉栓塞治疗。栓塞材料使用明胶海绵颗粒或PVA，血管粗大者加用明胶海绵条。常规行患侧锁骨下动脉、肋间动脉及对侧支气管动脉造影。以了解有无多支供血，发现供血血管则尽量行超选择插管栓塞治疗。肺癌患者根据不同病理类型行常规化疗灌注。结果：18例一次栓塞成功，3例两次栓塞成功，5例肺癌咯血栓塞后出血量明显减少。栓塞术后即时止血率80．77％，近期复发率7．69％，中远期复发率23．08％。结论：支气管动脉栓塞术治疗大咯血即时止血和近期疗效满意，中远期复发与栓塞材料吸收和原发病有关。     

肺癌经支气管动脉灌注化疗并发症的分析

目的：对肺癌经支气管动脉灌注化疗的并发症进行分析，并对其出现的原因，处理措施及如何预防做进一步探讨。方法：377例肺癌行支气管动脉灌注870次，均采用Sdldinger法穿刺，行支气管动脉内灌注化疗，结果：17例出现较严重的并发症，发生率为4．5％（17／377）。其中背部皮肤软组织损伤6例，术后大咯血5例，咽下疼痛及吞咽困难4 ，脊髓损伤2例，结论：并发症的发生与血管解剖，对比剂及化疗药物的毒性，介入器材的选择和操作有关，了解其发生的原因，可更好地预防和处理并发症。     

支气管动脉造影对肺癌分期和切除可能性的评价

为评价选择性支气管动脉造影(SBAG)在肺癌分期和估价切除可能性中的价值,对54例原发性肺癌进行治疗性SBAG.SBAG显示22例中心型肺癌中21例和32例周围型肺癌中29例原发肿瘤(T)大小。其估价肺门和纵隔的阳性例分别为11例和8例。阴性分别为13例和19例,假阳性分别为3例和1例。假阴性分别为1例和0例。术前SBAG正确提示9例不能切除肿瘤中的8例。治疗性SBAG对于肺癌的评价和治疗是有益的。可以作为评价肺癌的一种补充方法。     

经支气管动脉化学栓塞术治疗中心型肺癌的疗效分析

目的：探讨经支气管动脉化学栓塞治疗中心型肺癌的近期疗效。方法：对25例病理确诊的原发性中心型肺癌进行选择性支气管动脉插管造影，并将3F同轴微导管置于肿瘤的供血动脉内注入适当剂量的碘化油＋顺铂乳剂。结果：经支气管动脉化学栓塞治疗后，临床症状改善率为100％，且无严重并发症发生，1年生存率为72％（18／25）。结论：经支气管动脉化学栓塞术治疗中心型肺癌具有较好的临床疗效。