螺旋CT血管成像在肺癌侵犯

目的将螺旋CT血管成像(SCTA)技术应用于肺动脉成像,探讨肺癌侵犯中央肺动脉(CPA)的CTA影像特征.方法收集具有中央肺动脉受侵征象(CICPA)的中心型肺癌30例进行螺旋CT肺血管成像(SCTPA),并以30例正常SCTPA病例作对照.成像参数为扫描层厚3 mm,螺距1.5,重建间距1.2 mm,造影剂注射速度3～4     

单侧肺动脉主干阻断在肺癌肺叶切除中的应用

目的:探讨阻断单侧肺动脉主干在Ⅱ～Ⅲ期肺癌患者行肺叶切除中的应用.回顾分析肺动脉阻断的手术方法、适应证、术中注意事项及术后心肺并发症.方法:2006年1月至2008年1月对昆明医学院第三附属医院30例肺门解剖结构不清、肺血管分离困难的Ⅱ～Ⅲ期肺癌患者,先于心包内或心包外游离并阻断左(右)肺动脉主干,再按不同方法完成各种肺叶切除术.结果:30例患者中Ⅱ b期5例,Ⅲa期11例.Ⅲb期14例.术中见肺上叶巨大肿瘤13例(直径>10cm),其中心包外肺动脉被肿瘤侵犯5例;肺门淋巴结广泛肿大并与肺血管严重粘连20例;肿瘤组织部分侵犯心包7例;大部分病例肿瘤组织不同程度与主动脉、上腔静脉、奇静脉粘连;3例已侵犯左侧喉返神经和迷走神经.30例患者行单纯肺叶切除12例,肺叶袖状切除并肺动脉成形术18例.在单侧肺动脉主干阻断下,术中未出现肺血管大出血,手术视野清晰,30例患者均顺利完成肺叶切除及淋巴结清扫,保留了健康有功能的肺叶,避免了全肺切除,肺动脉阻断时间为10～30min.术中失血200～300ml.术后并发急性肺水肿5例,心动过速7例,经治疗均痊愈出院,全组无严重心肺并发症.结论:阻断单侧肺动脉主干行肺叶切除可有效预防术中大出血,缩短手术时间,并可提高肺癌切除率,降低全肺切除率.     

中央型肺癌致肺低灌注的数字减影血管造影表现初步研究

目的 分析肺癌侵犯中央肺动脉后致肺低灌注的数字减影血管造影（DSA）影像特征,探讨肺动脉受累程度与肺低灌注间的关系,为临床制定治疗方案提供更多的信息。方法 收集CT显示侵犯肺动脉的中央型肺癌患者26例,行肺血管DSA检查,观察肺低灌注的DSA影像特征,描绘受累肺叶及健侧对应区域肺实质时间－密度曲线（TDC）。结果 26例中38支叶肺动脉受侵,34个肺叶（89．5％）出现肺低灌注,肺低灌注与肺动脉受累后狭窄累后狭窄程度程度密度切相关（P＜0．05）。DSA像上肺血管征表现为肺动脉中断（11．8％,4／34）或分支数量减少（88．2％,30／34）,末梢肺动脉消失（41．2％,14／34）或减少（58．8％,20／34）,肺实质征表现为肺组织毛细血管充盈消失（14．7％,5／34）或减弱（85．3％,29／34）。结论 肺癌侵犯中央肺动脉后致该动脉供血区域出现肺低灌注,肺低灌注与肺动脉狭窄程度密切相关。肺实质征及肺血管征是肺低灌注的重要征象。     

Ⅲ期肺癌外科治疗适应证的初步分析

２年手术治疗肺癌５５例，术后病理分期，Ⅲ期肺癌２８例（占５０．９％），其中Ⅲ＿ｂ期３例。术前有７例行支气管动脉灌注化疗。２８例中，手术切除１９例，占６７．９％，无手术死亡。２年随访，中位存活期１１个月。２年累积存活率６９．０％。本文提出了Ⅲ期肺癌各亚组的手术适应证，包括（１）周围型肺癌侵犯壁层胸膜或胸壁或伴有Ｎ＿２者；（２）、中央型肺癌距隆重＜２．０ｃｍ者，或肿瘤侵犯上腔静脉或肺血管主干者；（３）小细胞肺癌属于Ｔ＿３Ｎ＿（０－１）Ｍ＿０者。     

小细胞肺癌外科为主的综合治疗结果

报告３０年间以外科为主综合治疗１０４例小细胞肺癌近远期疗效。切除８８例，切除率８４．６％。全肺切除１６例，常规肺叶切除（含双叶）６２例，袖式肺叶切除１０例，无切除死亡。临床ＴＮＭ分期：Ⅰ期７７例，Ⅱ期１９例，Ⅲａ期８例。病理ＴＮＭ分期；Ⅰ期４５例，Ⅱ期３２例，Ⅲａ期２５例，Ⅲｂ期１例，Ⅳ期１例。两者相比不符者达５４例。其中临床偏早者４６例，偏晚者８例。总随诊率９４．９％，总切除后５年生存率２７．５％。影响远期生存的可能因素为术式、病理分期以及术后辅助化疗。５年生存率：全肺切除与肺叶切除分别为１２．５％和３０．９％；Ⅰ、Ⅱ、Ⅲ期分别为３３．３％，１４．３％及３３．３％；有无辅助化疗者分别为３２．４％，及１６．７％。作者等提出，小细胞肺癌术前尽可能做到正确分期，Ⅰ、Ⅱ及Ⅲａ中的Ｔ３Ｎ０和Ｔ３Ｎ１病例适宜手术，术后皆应辅以化学治疗     

肺癌侵犯肺动脉干CT、MRI表现、病理基础及其对手术治疗的价值

目的研究肺癌侵犯肺动脉干(cancerous invasion of the main pulmonary artery, CIMPA)CT、MRI征象的病理基础及对手术治疗的价值.方法研究对象为中央型肺癌23例(螺旋CT 15例,MRI 13例).观察和分析其CT、MRI征象,并与手术/病理发现作前瞻性盲法对照研究.结果本组23例肺癌CIMPA的CT/MRI征象为管壁增厚征(CT 73.7%,MRI 84.6%),管腔缩窄征(CT 55.3%,MRI 69.2%)及管周脂肪征(CT及MRI均为100.0%).依肿块与血管的密切关系分为相贴型(CT 10例,MRI 7例),即肿块与血管相贴小于180°,无或轻度管腔狭窄;包埋型(CT 5例,MRI 6例),即血管被包埋大于180°,伴中至重度缩窄.手术发现相贴型10例,全部行肺叶切除并血管成型术.包埋型13例,7例全肺切除,4例肺叶切除并血管成型术,2例未切除.21例切除标本镜下观察癌肿侵犯肺动脉外膜100.0%(21例)、中膜66.7%(14例)、内膜4.8%(1例).相贴及包埋两型在癌肿浸润肺动脉深度上无显著性差异(P＞0.05);所有标本均显示急性或慢性炎性组织增生.CT、MRI与病理分型一致性好(Kappa值各为0.61、0.84).结论本组肺癌CIMPA的CT、MRI特征为肿块相贴或包埋血管,致管壁增厚及管腔缩窄但无闭塞,与癌肿主要侵犯肺动脉中、外膜伴结缔组织增生的病理表现相关.将病变分为相贴及包埋型有助于外科治疗计划的制订.     

手术治疗Ⅲ期肺癌38例

报告３８例Ⅲ期肺癌的手术治疗（Ⅲａ期３０例，Ⅲｂ期８例）。手术切除３３例，切除率８６．８％，其术后１年、３年存活率分别为３６．４８％、２１、４％。就肿瘤侵及壁层胸膜、肺静及心包、支气管与肺动脉时所采用的切除方式以及术中怎样判全肺切除进行讨论，认为在Ⅲ期肺癌手术中，根据不同的情况选用相庆术式，确能扩大手术适应症，提高手术切除率。     

巨块型肺癌外科治疗近期疗效的临床分析(附68例报告)

本文报告作者自1983年6月至1989年5月时间对68例巨块型(>6cm)肺癌的外科治疗结果。临床分期:Ⅰ期28例,Ⅱ期7例,Ⅲ期33例。手术方式:切除组58例中,全肺切除21例,肺叶切除37例,手术切除率85％。手术并发症发生率8.6％,手术死亡率1.7％。根据术中所见及病理检查:肿     

全肺切除术治疗肺癌

４０例全肺切除术占同期手术治疗肺癌的１７．５％，男３４例，女６例；年龄２０～６８岁；左全肺切除３０例；４０例病人中２５例属中心型肺癌，肿瘤最大直径大于５ｃｍ者２５例，占６２．５％。全肺切除原因中占前三位的分别是侵及相邻肺叶、肺动脉受侵及主支气管受侵，不少病例具备两项全肺切除原因。大部分病例行心包外全肺切除术并先结扎肺动脉。手术死亡率为５％，并发症发生率１７．５％。术后ＴＮＭ分期Ⅰ期占２．５％，Ⅱ期占２７．５％，Ⅲａ期占６７．１５％，Ⅲｂ期占２．５％。术后１年及３年生存率分别为５５．９％和３５．０％。支气管切端阳性术后未放疗的１０例全部死于１年以内。     

支气管肺动脉成形术治疗中心型支气管肺癌

背景与目的 血管成形术或血管、支气管双成形肺叶切除术已广泛应用于心肺功能储备差、不能耐受全肺切除的局部晚期肺癌患者。本文旨在总结近年来在肺癌手术中应用肺动脉支气管成形技术的体会，讨论手术适应症选择、术中具体方法、肺动脉重建等问题。方法 从1999年10月～2005年10月对26例中心型肺癌累及肺动脉患者施行肺动脉成形或肺动脉支气管双成形肺叶切除术，并最大限度地切除肺癌以最大限度地保留肺功能。结果 全组无手术死亡。术后2例出现肺不张，2例并发肺感染，1例肺再灌注损伤。全组术后1年生存率为100．0％，3年生存率为69．2％。结论 血管成形术或血管、支气管双成形肺叶切除术可达到与全肺切除同样的效果，特别适用于心肺功能储备差、不能耐受全肺切除的局部晚期肺癌患者。     

CT引导下经皮肺穿刺活检术对肺部占位性病变的临床诊断意义和安全性分析

目的:探索CT引导下经皮肺穿刺活检术的临床应用价值，分析产生并发症的原因和主要影响因素。方法:回顾2015年03月到2017年03月在哈尔滨医科大学附属第二医院肿瘤内科行CT引导下经皮肺穿刺活检术的138例病例资料，总结其诊断准确率、并发症的发生率及其影响因素。结果:成功获取138例患者组织标本，其中130例获得明确诊断，定性诊断率94.2%（130/138），一次活检阳性率81.9%（113/138）；二次活检阳性率76.5%(13/17)；三次活检阳性率100%（4/4）。并发症发生率为14.5%(20/138)，其中胸膜反应1.4%（2/138）、气胸3.6%（5/138）、小咳血8.0%（11/138）、针道渗血1.4%（2/138）。所有并发症均经临床观察和对症处理后缓解，无严重并发症发生。结论:CT引导下经皮肺穿刺活检术临床价值高，适用于肺部疾病的诊断，是一种创伤性小、确诊率高、安全性较好的方法。     

Partial anomalous pulmonary venous return in patients with pulmonary hypertension

Anomalous pulmonary venous return is an uncommon congenital malformation, and may be partial or total. Partial anomalous pulmonary venous return (PAPVR) is more common than total anomalous pulmonary venous return, and is often associated with other congenital cardiac anomalies. Whilst many patients with PAPVR remain asymptomatic, some may present in later age with symptoms related to left-to-right shunt, right heart failure and pulmonary hypertension. We report two cases of PAPVR detected on Computed Tomography Pulmonary Angiogram (CTPA) for the work up of pulmonary hypertension. The cases demonstrate that, although uncommon, partial anomalous pulmonary venous return can be a contributing factor to pulmonary hypertension and pulmonary veins should be carefully examined when reading a CTPA study.     

Application of blocking unilateral main pulmonary artery in pulmonary lobectomy of lung cancer

OBJECTIVE To explore the application of blocking the unilateral main pulmonary artery （MPA） in pulmonary lobectomy （PL） for patients with stage Ⅱ and Ⅲlung cancer, and to retrospectively analyze the methods of surgery for blocking the unilateral main pulmonary artery, perioperative indications, intraoperative concerns and postoperative cardio-pulmonary complications. METHODS During a period from January 2006 to January 2008, intra-pericardial, or extra-pericardial separation and blockade of the left or right MPA followed by completion of various PLs were conducted for 30 lung cancer patients in stage-Ⅱto Ⅲwith ill- defined anatomic structure of the pulmonary hilum and difficult pulmonary angiodiastasis. RESULTS In the 30 patients, 5 were diagnosed as stage-Ⅱb, 11 stage-Ⅲa, and 14 stage-Ⅲb. During the surgery, giant tumors at the superior pulmonary lobe, with a diameter of over 10 cm, were seen in 13 cases, in which tumor invasion in the extra-pericardiac pulmonary artery was found in 5 cases. Hilar lymphadenectasis with severe tumor adhesion to pulmonary blood vessel could be seen in 20 cases and partial tumorous invasion in the pericardium in 7. In most of the cases, adhesions existed around the tumor, aorta, superior vena, and azygous vein. Invasion of the laryngeal and vagus nerves on the left side was found in 3 cases. Of the 30 patients, simple PL was conducted in 12, and sleeve lobectomy combined with a pulmonary arterioplasty in 18 cases. With a blockade of unilateral MPA, no intraoperative hemorrhea of pulmonary blood vessels occurred during surgery, when there was a clear surgical field of vision. Both PL and lymphadenectomy were smoothly completed in the 30 patients. The healthy pulmonary lobes with normal function were kept and total pneumonectomy was avoided. The time of blocking the pulmonary artery ranged from 10 to 30 min, and intraoperative blood loss was from 200 to 300 ml. Postoperative complicated acute pulmonary edema occurred in 5 patients and tachycardia in 7 cases. Nevertheless, all patients recovered and left the hospital after treatment. No severe cardiopulmonary complications were found in all patients of the group. CONCLUSION Blocking the unilateral MPA is effective to decrease the risk of intraoperative hemorrhea in the PL. It can shorten the time of surgery, improve the excision rate of lung cancer, and cut down on the rate of total pneumonectomy.     

Multidetector CT pulmonary angiography features of pulmonary embolus

Pulmonary embolism (PE) is a life-threatening condition. Multidetector CT pulmonary angiography is currently the imaging method of choice for the detection of PE. The aim of this pictorial essay is to review the appearances of PE on multidetector CT pulmonary angiography, including signs that differentiate acute and chronic PE and markers of severity. The features of a non-diagnostic study and pitfalls leading to a false-positive or false-negative study are presented.     

Computed tomography pulmonary angiogram diagnosis of pulmonary embolism

Over the last decade, contrast‐enhanced spiral CT has been established as a non‐invasive alternative to catheter angiography and is now regarded as the first‐line imaging investigation for the diagnosis of pulmonary embolism (PE). The reported sensitivities for the diagnosis of PE of spiral CT vary from 45 to 100% and the specificities vary from 78 to 100%. Prospective outcome studies have shown a high negative predictive value for a single‐detector spiral CT for PE. Patients’ outcomes were not adversely affected in these studies when anticoagulation was withheld after a negative CT pulmonary angiogram. The main limitation of single‐detector spiral CT has been its limited ability to detect isolated subsegmental PE. However, multidetector spiral CT allows evaluation of pulmonary vessels down to sixth‐order branches and significantly increases the rate of detection of PE in segmental and subsegmental levels. The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. If appropriate equipment is available (multidetector CT), then CT pulmonary angiogram is safe to be used as the first‐line imaging investigation for the diagnosis of PE.     

心包内肺动脉预置阻断带在肺动脉干受侵肺癌手术中的应用

背景与目的 肺动脉干受侵的局部晚期非小细胞肺癌是肺癌外科难点之一.本研究的目的是探讨心包内肺动脉预置阻断带在心包外肺动脉干受侵肺癌手术中的价值.方法 术前影像学检查和术中探查判定肺动脉受肿瘤侵犯者,术中先行心包切开,游离患侧心包内肺动脉干,预置阻断带.结果 28例患者中18例术中实施了肺动脉阻断.全组病例无术中大出血,肿瘤均完全切除,未行全肺切除术.结论 心包内肺动脉预置阻断带能提高肺动脉干受侵肺癌手术的安全性和肿瘤切除的彻底性,减少全肺切除的施行.     

肾上腺髓质素与肺癌关系的研究进展

目的:总结国内外对肾上腺髓质素与肺癌的研究进展.方法:应用PubMed及CHKD期刊全文数据库,以"肽、肾上腺髓质素、肺、肿瘤"等为关键词,检索1993-01-2009-09相关文献40篇.纳入标准:1)肾上腺髓质素在肺部肿瘤中的表达.2)肾上腺髓质素对肺部肿瘤细胞的作用.3)肾上腺髓质素对血管生成的影响.4)肾上腺髓质素的作用机制研究.根据纳入标准符合分析的文献21篇.结果:肾上腺髓质素(ADM)在多种肿瘤组织和肿瘤细胞中表达,肺癌细胞是ADM的重要靶细胞.ADM通过诱导c-fos、c-jun和egr-1等不同早期反应基因、癌基因和与癌周细胞交互作用而调控肺癌细胞的活动.缺氧是肿瘤生长微环境的基本特征之一,缺氧通过缺氧诱导因子-1(HIF-1)调控肺癌细胞ADM的表达.ADM受体抗体AMRs能够抑制肺肿瘤血管生成和肿瘤的生长.结论:ADM可能参与肺癌的发生、发展,阻断ADM的作用通路可部分或全部阻断ADM对肿瘤的作用,ADM有可能成为肺癌治疗新的靶点.