血管内支架置入联合放疗治疗肺癌合并上腔静脉综合征的临床观察

目的 探讨血管内支架置入联合放疗治疗肺癌合并上腔静脉综合征（SVCS）的临床疗效。方法 46例肺癌伴SVCS患者分为支架置入联合放疗组（n=23）和单纯放疗组（n=23）。Seldinger 法穿刺置入支架；采用6MV X线行三维适形放疗，常规分割2Gy／次，5次／周，总剂量达50～60Gy/5～6周。评价疗效及毒副反应，并随访患者的生存情况。结果 支架置入联合放疗组患者于血管支架植入术后1周内症状消失；单纯放疗组患者于放疗后4周症状消失。支架置入联合放疗组获CR 19例、PR 4例，单纯放疗组获CR 12例、PR 5例、NC 4例、PD 2例。支架置入联合放疗组总有效率为100.0％，高于单纯放疗组的73.9％（P＜0.05）；联合放疗组3、6、9、12个月生存率均高于单纯放疗组（P＜0.05）。两组常见不良反应为骨髓抑制、放射性肺炎和胃肠道反应，均以1～2级为主，差异均无统计学意义（P＞0.05）。结论 血管内支架置入联合放疗可迅速解除梗阻症状，疗效好，生存期延长，值得进一步临床研究及推广应用。

Combined effects of endovascular stent placement and radiotherapy on lung cancer with superior vena cava syndrome-A clinical research

Objective To evaluate the combined effects of endovascular stent implantation and radiotherapy on lung cancer with superiorvena cava syndrome（SVCS）. Methods Forty-six cases of lung cancer with SVCS were randomly divided into the com- bined stent placement and radiotherapy group （ combined group） and radiotherapy alone group. The stent was implanted using seldinger method. All patients were treated with three dimensional conformal radiation therapy, 2Gy/fraction,5 fractions a week,DT 50-60Gy,5- 6 weeks. The rate of clinical effect, survival and side effects of both groups were observed and compared. Results The symptoms were alleviated in combined group one week after stent implantation, while symptoms were alleviated in radiotherapy alone group 4 weeks after radiation. The patients in combined group got 19 CR and 4 PR, and patients in radiotherapy alone group got 12 CR, 5 PR, 4 NC and 2 PD. The response rate of combined group was 100. 0%, higher than that of radiotherapy alone group（73.9% ） with signifi- cant difference （ P 〈 0. 05 ） ; 3-, 6-, 9-, 12-month survival rate of combined group were higher than those of radiotherapy alone group （P 〈 0.05）. The common side effects were bone marrow suppression, radioactive pneumonia and gastrointestinal reaction, mainly in grade 1-2. There was no difference between two groups （ P 〉 0. 05 ）. Conclusion The endovascular stent implantation in combination with radiotherapy can relieve the obstruction quickly. So it has higher therapeutic effect and longer remission time than radiotherapy a- lone. It is worth of further study and expand in the clinical application.