经纤维支气管镜局部注射药物治疗肿瘤引起的大气道阻塞

目的　观察经纤维支气管镜 (纤支镜 )局部注射抑瘤仙 (对邻甲苯磺酰胺类化合物 ,为致肿瘤坏死物质 )治疗大气道肺癌的疗效及毒副作用。方法　 2 2例中晚期大气道肿瘤患者 ,经纤支镜在肿瘤局部多点注入抑瘤仙 2～ 3ml,如有坏死组织钳取后再注射 ,每周 2次。结果　注药后 2～ 4d肿瘤局部变白、变黑 ,与周围正常组织分界清楚 ,易钳取且出血不多 ,病理检查为坏死组织。经 4～ 16次、平均 (6 5± 2 5 )次治疗后 ,气道阻塞完全缓解 7例 (3 2 % ) ,部分缓解 12例 (5 4% ) ,有效率 86%。注药后部分患者有轻度的疲乏、嗜睡、食欲下降。 1例右主支气管完全堵塞的患者第二次注药时出现严重呼吸困难 ,插管通气 3d后缓解。可能与基础肺功能差、药物刺激、患者较敏感有关。结论　此方法对大气道肺癌疗效较好 ,起效快 ,选择性高 ,但应注意其可能刺激气道的副作用

Treatment of large airway obstruction due to lung cancer with local injection of Immusyn via bronchoscopy

Objective　To investigate the efficacy and safety of local injection of Immusyn, a para tolunsulfonamide compound which is a tumor nacrotizing agent, into the tumor in large airway via fibrobronchoscopy.Methods　22 patients with lung cancer (5 with stage Ⅲa, 17 with stage Ⅲb and Ⅳ) were enrolled into the study. Large airway obstruction due to tumor invasion was confirmed by fibrobronchoscopy and biopsy. Injection of Immusyn into the tumor inside the lumen of large airway was conducted two times a week (3～5 points of injection with total volume of 3～5 ml). The treatment was repeated 4～16 times (6.5±2.5).Results　Tumor necrosis occurred after injection. The necrosis tumor tissue appeared to be white and/or black in color after injection, which was obviously different from adjacent normal tissue and was easy to be removed through fibrobronchoscopy. Necrosis of the removed tissue was confirmed by pathological examination. After 2 to 6 weeks of treatment, complete relief of large airway obstruction (CR) was shown in 7 cases, partial relief (PR) in 12 cases and no change (NC) in 3 cases. The total effective rate was 86.4%. Adverse effects were rare, with slight somnolence, anorexia and diarrhea in some patients, which recovered spontaneously. Severe dyspnea occurred in one patient when she received the injection for the second time, who was completely recovered after intubation and mechanical ventilation for 3 days.Conclusion　Local injection of Immusyn is an effective treatment in relieving large airway obstruction due to malignant tumor.