中晚期肺癌介入治疗的临床观察

目的探讨经皮支气管动脉灌注化疗药物(bronchi alartery infusion,BAI)与病变供血血管、肿瘤组织学分类、疗效之间的关系。方法对52例原发性中晚期肺癌行BAI,对治疗效果进行总结。结果富血管型的近期疗效明显优于乏血管型。中心型肺癌的近期疗效优于周围型肺癌。多次灌注治疗的疗效优于单次灌注,临床分期的近期疗效与治疗效果无关。结论肿瘤供血与肿瘤介入治疗疗效有直接关系。肺癌的病理类型、生长部位、血供类型和灌注次数等是影响疗效的主要因素。     

膈下动脉参与肝脏肿瘤供血的影像与介入治疗

目的研究膈下动脉参与肝肿瘤供血的影像表现和介入治疗效果.方法经血管造影证实膈下动脉参与肝脏肿瘤供血17例,男12例,女5例,年龄32～59岁,既往均有肝动脉化疗栓塞史(2-6次).膈下动脉造影用5FCobra导管,对向肿瘤供血的膈下动脉分支行栓塞治疗,1例用同轴微导管.结果肝脏肿瘤均为巨块型,位于肝脏上部,接近膈肌或/和肝包膜.膈下动脉造影均为右侧膈下动脉以终末支方式参与肿瘤供血,栓塞治疗成功.术后复查CT显示肿瘤缩小或/和瘤区碘油积聚增多,末次治疗前13例AFP＞20μg/L,术后逐渐下降或正常.结论位于肝脏上部、接近膈下或/和肝包膜的肿瘤可接受右膈下动脉供血,在经膈下动脉栓塞治疗时应注意膈肌痉挛并发症.     

经肺动脉与支气管动脉血管造影的CTA观察原发肺癌的血供

目的用支气管动脉(BA)和肺动脉(PA)造影CTA观察肺癌血供情况。方法前瞻性观察6例支气管肺癌患者,分别行体循环动脉和肺动脉数字减影血管造影(DSA)后,留置BA导管与PA导管行CTBA与CTPA,观察BA与PA对肺癌的血供。结果CTPA上,无体动脉与左心强化的图像上肿瘤未见强化,有体动脉或左心强化的图像上见肿瘤边缘强化,CT强化值为10.0~45.6 Hu。CTBA上肿瘤部分明显强化,CT强化值为150.3~320.7 Hu,可见杂乱无章的肿瘤血管影,3例见纵隔淋巴结强化。结论本组病例观察表明原发性肺癌由BA为主的多发体循环动脉供血,未发现PA参与供血。     

食管癌血供的DSA研究和介入治疗的临床价值

目的探讨食管癌血液供应特点,明确食管癌区域淋巴结转移的DSA征象,指导食管癌的TNM分期和综合治疗。方法采用Seldinger技术对66例经食管钡剂X线造影及病理学证实的上、中胸段食管癌患者予以支气管动脉及其他可能肿瘤供血血管造影,依造影结果在靶血管内化学药物灌注(食管癌介入治疗)。结果食管癌有多支、多源、节段性供血的特点,DSA动脉造影可显示区域淋巴结的转移征象,能明确肿瘤血管及肿瘤染色,食管癌介入治疗效果满意。结论DSA造影能明确食管癌区域淋巴结及肺转移等情况,是预测和指导食管癌外科根治性切除的一个客观指标,介入治疗是食管癌综合治疗的一个重要方法,术前应用更有积极意义。     

多层螺旋CT血管成像在支气管动脉灌注化疗前的定位价值

目的探讨多层螺旋CT血管成像(MSCTA)在支气管动脉(BA)灌注化疗前的定位价值。方法分析15例经支气管动脉介入治疗前的的肺癌病例,中央型13例,周围型2例。15例均行螺旋CT增强扫描,后传至工作站利用多平面重组(MPR)、最大密度投影(MIP)和容积再现(VR)等后处理技术观察支气管动脉。结果13例中央型肺癌均由肿瘤性支气管动脉供血,重建图像清晰显示肿瘤性支气管动脉的起点、分支情况及走行特点;其中2例右侧肿瘤性支气管动脉与肋间动脉共干。2例周围型肺癌中有1例由肿瘤性支气管动脉供血,1例找不到明确发自支气管动脉的供血血管。结论多层螺旋CT血管成像能够显示肺癌特别是中央型肺癌的肿瘤性支气管动脉并能为经支气管动脉灌注化疗提供准确定位。     

支气管扩张症伴咯血患者的供血动脉解剖学分型及DSA表现

目的分析支气管扩张症伴咯血患者的供血动脉解剖分型及DSA表现。方法收集接受经导管动脉栓塞术的支气管扩张症伴咯血患者62例,其中男36例,女26例,结合胸部CT及术中数字减影血管造影(DSA)确定其供血动脉,分析供血动脉的解剖学分型及DSA表现。结果 62例患者均在栓塞过程中接受DSA检查,21在栓塞治疗前接受增强CT检查。DSA示10例单纯支气管动脉供血;34例异常支气管动脉供血,其中主干型14例(支气管动脉增粗、纡曲扩张11例,支气管动脉瘤样扩张3例),网状型12例,多种动脉交通吻合型8例;18例非支气管源性动脉供血,其中肺动脉供血4例,肋间动脉供血12例,支气管动脉与肺动脉形成吻合血管网者2例。结论支气管扩张症伴咯血与供血动脉的解剖异常有关,了解其解剖特点有利于临床开展介入治疗。     

肺癌选择性支气管动脉灌注化疗的临床分析

目的：探讨选择性支气管动脉灌注化疗（ＢＡＩ）对中晚期肺癌的疗效及影响因素。方法：对６９列中晚期肺癌进行ＢＡＩ治疗,根据不同病期,组织类型,病变部位,肿瘤血管构型,血供类型及操作技术进行分析,结果：（１）中央型小细胞未分化癌及鳞癌,多血管构型,少血供者与周围型,腺癌,少血管构型,多血供患者之间疗效差异有显著性,前者优于后者（Ｐ〈０．０５）。（２）６９例中ＢＡＩ后肺内局部病变完全缓解（ＣＲ）１５例（２     

腹腔镜肝切除的术前血管预处理

目的 探讨术前肿瘤供血动脉及门静脉血管内阻断在腹腕镜肝切除中的.1例肝海绵状血管瘤及1例肝癌患者,于术前1h数字减影下经股动脉插管入肝动脉,造影后超选择至肿瘤的供血动脉,用明胶海绵行动脉栓塞完毕即经B超引导穿刺肿物的供血门静脉,超声监视下注入TH生物胶5ml,栓塞肿瘤的供血门静脉干,而后在腹腔镜下行肝肿瘤切除。结果 经血管内阻断后分离肝组织时出血明显减少,病例1术中出血约300ml,病例2术中出血约200ml,手术经过顺利,术后恢复良好。结论 术前肿瘤供血动脉及门静脉的血管内阻断对减少腹腔镜肝切除术中出血具有极其重要的作用。     

MSCTA对肺腺癌及肺鳞癌L1R1型支气管动脉的对比分析

目的采用MSCTA及后处理技术分析肺腺癌及肺鳞癌L1R1型支气管动脉开口直径差异,为提高插管成功率提供有价值的临床信息。方法收集45例肺腺癌L1R1型支气管动脉MSCT图像,68例肺鳞癌L1R1型支气管动脉图像,测量并比较肺腺癌及肺鳞癌L1R1型支气管动脉开口直径差异。结果肺腺癌L1R1型左右两侧支气管动脉开口直径,肺鳞癌L1R1型左右两侧支气管动脉开口直径差异均有统计意义(P均0.05);肺腺癌与肺鳞癌L1R1型左侧支气管动脉、右侧支气管动脉开口直径比较均差异均无统计学意义(P均0.05)。结论 MSCTA及后处理技术有助于了解肺腺癌L1R1型支气管动脉、肺鳞癌L1R1型左右两侧支气管动脉差异,为临床开展介入治疗,提供有价值的临床信息。     

肝癌动脉血供初步研究

目的分析肝癌的动脉供血特点。方法分析有完整血管造影资料的肝癌患者366例,肝右叶肿瘤287例,肝左叶肿瘤49例,横跨左右叶者30例。常规行腹腔动脉、肠系膜上动脉数字血管造影,对可疑病例加行膈动脉、胃左动脉、脾动脉、右肾动脉、胸廓内乳动脉、支气管动脉等数字血管造影。结果参与肿瘤供血动脉,1条者157例(42.90%),2条者136例(37.16%),3条者57例(15.57%),4条者14例(3.82%),6条者2例(0.55%)。肝右动脉占50.71%(319/629),肝左动脉占26.39%(166/629),肝中动脉占1.27%(8/629),左膈动脉占0.79%(5/629),右膈动脉占6.20%(39/629),肠系膜上动脉占2.86%(18/629),胃左动脉占6.36%(40/629),胃十二指肠动脉占4.29%(27/629),右肾上腺动脉占0.64%(4/629),右支气管动脉、脾动脉、右胸廓内乳动脉均各占0.16%(1/629)。结论肝癌的血供来源以多动脉为主,除肝动脉供血外,非肝动脉分支的寄生供血也常见。     

Evaluation of the blood supply to the bronchial stump following resection of the lungs using a mechanical suture in the diagnosis and treatment of pulmonary hemorrhage

The authors analysed angiograms of 34 patients who had been operated on the lungs with the use of mechanical suturing instruments to determine the effect of the mechanical suture (MS) of the bronchial stump on the development of hemoptysis and pulmonary hemorrhage. They studied the possibility of applying transcatheter endovascular occlusion (TEO) of the bronchial arteries (BA) in the management of hemoptysis of this etiology. In 70% of patients hyperplasia of the BA developed in the MS region in the late postoperative period; which was the source of pulmonary hemorrhage in 75% of cases. Among the patients, 19 were subjected to BA TEO for pulmonary hemorrhage. In 13 cases the bronchial stump with MS was the source of hemorrhage. Hemoptysis is a late complication of lung resection with the use of MS. Preference should be given to BA TEO in the management of this complication.     

Hypervascular vestibular schwannomas

BACKGROUND: Vestibular schwannoma (VS) is usually hypovascular and can be resected totally without major morbidity. Resection of the more uncommon hypervascular VS is complicated by excessive tumor bleeding. We have attempted to clarify the clinical characteristics and management of hypervascular VS. METHODS: Surgical reports and videos of 78 patients with unilateral VS (5 hypervascular, 73 nonhypervascular) were retrospectively reviewed and clinical characteristics, radiological findings, and case management were compared. RESULTS: Hypervascular VS presented at a younger age than nonhypervascular VS (29 +/- 12 vs. 52 +/- 16 years old) (p < 0.01). Magnetic resonance imaging (MRI) showed that hypervascular VS was solid, without tumor cyst, and significantly larger than nonhypervascular VS (p < 0.05). The surface of hypervascular VS consistently showed multiple flow voids representing large draining veins. The characteristic angiographical findings of hypervascular VS were extensive tumor vessels, tumor stains, and early filling of draining veins; vertebrobasilar arteries supplied hypervascular VS. A multi-stage surgical approach was used since torrential tumor bleeding in the first surgery interfered with resection, resulting in partial tumor removal. Angiography before the second surgery showed much reduced tumor vascularity, bleeding was much reduced, and tumor was resected with less difficulty. In this approach, all 5 hypervascular VS were resected totally (1 case) or near-totally (4 cases) without major morbidity. CONCLUSIONS: Hypervascular VS, a solid and large tumor, presents at an earlier age. Although angiography provides characteristic findings, MRI can confirm the diagnosis of a hypervascular VS by showing multiple flow-voids on the tumor surface. Since partial tumor removal (first surgery) extensively reduces tumor vascularity and intraoperative tumor bleeding considerably, hypervascular VS should be managed by a multi-staged surgical approach.     

Angiographic and histopathological study on bronchial-to-pulmonary vascular anastomoses on explants from patients with cystic fibrosis after bronchial artery embolisation

Labelled backgroundHaemoptysis is a life-threatening complication of cystic fibrosis (CF). One treatment is bronchial artery embolisation (BAE) using embolic-microspheres (EMs). During BAE, pulmonary arteries can be seen on digital subtracted angiography while iodine containing contrast material injection is performed in the bronchial artery. This suggests that EMs could go from bronchial to nontarget pulmonary arteries. The aim was to evaluate if EMs could be found inside pulmonary arteries on lung explants after BAE in transplanted CF patients.MethodsRetrospective observational study including patients with CF who underwent lung transplantation and had previously needed BAE. Clinical, chest CT angiography, and angiographic data were reviewed from medical records. Pathology examination of lung explants was performed to analyze the EMs anatomical localisation.ResultsEight patients were included between 2013 and 2015, four males with a mean age of 29 (19-45) years. All patients had bronchial artery hypertrophy on CT and bronchial-to-pulmonary artery shunting during BAE. On pathology examination, EM ≤800 µm were found in the pulmonary arteries in all patients and were responsible for distal branch occlusions. Two pulmonary infarcts were observed on CT angiography after BAE and confirmed histopathologically.ConclusionsEM migration from the bronchial to pulmonary arteries is a common occurrence after BAE in patients with advanced stage CF. Although BAE is a highly effective means of controlling haemoptysis in CF, studies on the optimal particle size are needed to preserve pulmonary artery circulation, because these results suggest that low size EMs could lead to nontarget embolisation.     

多层螺旋CTA对肝脏肿瘤介入化疗及栓塞治疗的指导意义

目的探讨多层螺旋CTA在肝脏肿瘤介入化疗及栓塞治疗中的应用价值。方法对32例肝脏肿瘤患者行MSCTA检查,再行肝脏动脉DSA造影并介入化疗及栓塞治疗。结果以DSA造影作为标准进行比较,MSCTA检出变异动脉10例,准确率为100%,肿瘤明确供血动脉30例,准确率为93.75%。显示肿瘤染色24例,异常肿瘤血管20例,门静脉癌栓7例,动静脉短路4例,与DSA造影所见具有高度的一致性,且对门静脉显影及癌栓的显示优于DSA。结论MSCTA能准确显示变异血管、肿瘤的肝外供血动脉,有无门静脉受累及受累程度,对肝脏肿瘤的介入化疗及栓塞治疗有重要的指导意义。     

Coil embolization to treat pulmonary sequestration in the right upper lobe

Although there have been a few case reports of pulmonary sequestration, it is primarily located in the lower lobe and left lung, rarely in the right upper lobe. Here, we report a case presented with haemoptysis. Computed tomography images revealed flake ground-glass shadows in the right upper lobe. Computed tomography angiography demonstrated an artery supplied the affected lesions stemmed from the aortic arch. We diagnosed and treated her with bronchial artery angiography with coil embolization. No complications were found after operation until now. Thus, CTA could help identify the abnormal blood vessels, and interventional therapy may be an effective alternative to surgery of pulmonary sequestration.     

Intralobar pulmonary sequestration

Sequestration is defined as an area of abnormal pulmonary tissue not connected with the bronchial tree, supplied by an aberrant systemic artery and without a normal pulmonary function. Extralobar (ELS) and intralobar (ILS) forms are distinguished. During the year 2002 the authors diagnosed and operated upon two cases of the intralobar form of pulmonary sequestration, and in last 25 years five cases - 4 x ILS and 1 x ELS. Reported are a 35 year old man with relapsing infections of the sequester and a 21 year old woman where the sequestration was accidentally found without clinical symptoms. The focus was localized in both cases in the left lower lobe of the lungs, anomalous supply arteries derived from the thoracic aorta. Venous drainage of the sequester was different - in the man a systemic drainage via the v. azygos, in the woman via the pulmonary veins was found. In one case the diagnosis was made on the basis of angiography and computer tomography, in the other case it was made on the basis of multidetector CT angiography (MDCTA). Both findings were treated by primary surgical intervention lobectomy. The postoperative course was uneventful.     

Thoracoscopic Bronchial Artery Resection for Multiple Bronchial Artery Aneurysms

We describe a 36-year-old asymptomatic female with multiple bronchial artery aneurysms (BAAs) and a bronchial artery (BA) to pulmonary artery (PA) fistula. She was treated with thoracoscopic BA resection without lobectomy in lieu of catheter embolization as first-line treatment. The configuration of the BA and the location of the BAAs were clearly visualized using three-dimensional computed tomography (3DCT); therefore, the segment of the BA to resect was assessed preoperatively and complete resection of all BAAs was performed. Preoperative BA angiography delineated the BA to PA fistula, and guided surgical decision-making.     

栓塞治疗肺结核大咯血的临床疗效分析

目的探讨栓塞治疗肺结核大咯血的临床疗效。方法28例肺结核导致的急性大咯血患者，先作选择性支气管动脉及相关血管的DSA检查，明确出血部位及供血血管后，行超选择性插管，用明胶海绵和（／或）PVA栓塞。结果28例咯血患者，27例栓塞成功，1例栓塞4支供血动脉中的3支。咯血立即停止25例，咯血明显减少2例，1例咯血较前减轻。即时止血率89．3％，有效率100％。25例随访6～36月，近期复发咯血2例（8．0％），均无脊髓损伤等严重并发症发生。结论栓寒治疗是肺结核大咯血的有效止血手段；准确、完整地找到供血血管并运用恰当材料进行栓塞是有效止血并减少术后复发的关键。