肺癌术后行肺动脉灌注化疗的探讨

目的:通过前瞻性对照研究,比较肺动脉灌注化疗与外周静脉化疗对中晚期肺癌行肺叶切除术后的治疗效果。方法:病人分为2组(每组45例),PAI 组于肺叶切除后行选择性肺动脉置管于手术侧剩余肺叶间动脉内,灌注化疗。Ⅵ组则于术后用外周静脉给药途径化疗。结果:PAI组共化疗215疗程,平均4.7疗程,Ⅵ组化疗195疗程,平均4.3疗程。PAI组根治手术病例1、3、5年生存率94％、84.6％、52.9％,Ⅵ组1、3、5年生存率为87.5％、60％、22.2％,其中3、5年生存率有显著性差异 P<0.05。Ⅵ组行姑息手术病例 1年生存率 45％,无 3年生存率。PAI 组姑息手术病例 1、3年生存率为50％、33.3％优于Ⅵ组,但无统计学差异。PAI组根治手术病例3年局部复发率为12.8％,Ⅵ组为35％,有显著性差异,P<0.05。PAI组 1、3、5年血行转移复发率为 17.8％、20％、26.3％,Ⅵ组为15.5％、35％、51.3％,其中3、5年血行转移率减少有显著性差异P<0.05。结论:选择性肺动脉灌注化疗作为一种新的化疗方式,用于肺叶切除术后的肺癌患者,具有提高局部化疗药物浓度、增强化疗效果的作用,能够杀灭和抑制局部微转移灶,减少局部复发和远期血行转移的发生率,改善长期生存率。

Study of pulmonary artery infusion following lobectomy in the lung cancer patient

Objective: To evaluate the effect of pulmonary artery infusion(PAI) in chemotheraphy viaindwelling catheter for lung cancer patients after lobectomy. Methods: Ninety patients with abvanced lungcancer were randomized into two groups after lobectomy, each group had 45 patients.The treated groupwere given chemotheraphy via lobe's pulmonary artery which is adjacent to the rescted one,while the con-trol group received chemotheraphy via pripheral vein. Results: The treated group received 215 cycles ofchemotheraphy in total and 4.7 cycles in average, the control group received 195 cycles in total and 4.3cycles in average. The 1 - 3 -, 5 - year survival rates in treated group were 88.9%, 77.8%, 47.4% re-spectively. And there were 82.2%, 53.3%, 20.5% in the control group respectively. The 3 -, 5 - yearsurvival rates between 2 groups have statistical significance(P<0.05). Of these palliative lobectomy pa-tients in the control group,the 1-year survival rate was 40% and 3-year survival rate was zero.The 1-, 3-year survival rates were 50%, 33.3% for palliative lobectomy patient respectively in the treated group,but it is not higher than that of control group statistically. The 3-year recurrence rate was 12.8% for radi-cal lobectomy patient in the treated group and 35% in the control group(P<0.05). The 1-, 3-, 5- yearmetastasis rates following lobectomy were 17.8%, 20%, 26.3% in the treated group and 15.5%, 35%,51.3% in the control group respectively .The 3-, 5-year metastasis rates were significantly lower than thatof control group(P<0.05). Conclusion: The above results suggest that the PAI used in lung cancer pa-tients following lobectomy as a new way of chemotheraphy can ensure the high dose chemotheraphy in lo-cal area and increase its effcacy. It can also reduce the post-operative recurrence and metastasis in lungcancer patients.