支气管动脉灌注(BAI)治疗对中央型支气管肺癌的疗效分析——CT与病理学对照研究

目的 观察支气管动脉灌注（BAI）对中央型支气管肺癌的疗效并进行CT与病理学对照研究。方法 对27例经组织学证实的中央型支气管肺癌进行支气管动脉灌注（BAI）治疗。通过对比疗前、疗后CT评价原发灶及纵隔淋巴结等的改变；21例BAI治疗后限期手术切除，对照分析其疗后CT和病理学的表现。结果 疗后病灶较前缩小23例（23/27），纵隔肿大淋巴结疗后较前缩小16例（16/22），BAI治疗后病灶与周围结构关系有改善者8例（8/19），BAI后肺不张明显改善或消失12例（12/15），BAI治疗使病变T分期下降8例（8/27），使病变N分期下降1例（1/27），临床分期下降2例（2/27）。BAI后病理学检查发现残存肿瘤细胞周围伴有坏死（10/21）、间质纤维化（10/21）等成分，有时可有出血（1/21）或钙化（2/21）等，BAI后手术切除病例中，5（5/21）例在原发灶及纵隔淋巴结内均未发现残存肿瘤成分。坏死成分的CT表现为肿瘤中心的不规则低密度区，或伴有空洞（6/10）。其余病理改变没有特征性的CT表现。结论 支气管动脉灌注（BAI）治疗对中央型支气管肺癌有较好的近期疗效。CT扫描可以从病变大小和密度的改变方面评价BAI的疗效。但在反应残存肿瘤及肿瘤坏死、纤维化的构成比等组织学改变方面，CT仍有局限性。

The Curative Effect Analysis of Bronchial Arterial Infusion(BAI) on Central Bronchiogenic Lung Cancer :Serial CT Findings with Pathologic Correlation

Objective To describe the changes of primary tumor and mediastinal lymph nodes of lung cancer on CT after bronchial arterial infusion (BAI) and to correlate the CT findings with pathology. Methods 27 patients with histologically confirmed lung cancer underwent BAI .Changes of primary tumor and mediastinal lymph nodes before and after therapy were assessed using CT.Of 21 cases were performed operation after BAI .The CT findings were correlated with pathologic findings. Results With BAI therapy ,primary tumor was reduced in diameter in 23(23/27) cases and mediastinal lymph node was reduced in diameter in 16(16/22) cases. Decrease in T and N staging was achieved in 8(8/27) and 1(1/27) cases respectively ,decrease in clinical staging was achieved in 2 (2/27)cases.On pathological examination,the remaining tumor consisted of residual tumor cells,fibrosis(10/21),necrosis(10/21),hemorrhage(1/21) or calcification(2/21) and so on. No residual tumor cell was found in both primary tumor and mediastinal lymph nodes in 5(5/21) cases after BAI.The CT findings of necrotic area of the tumor after BAI were low attenuation area with irregular edge or with cavity(6/10). The CT findings of other pathological changes were not characteristics. Conclusion BAI therapy is useful for central bronchiogenic lung cancer.To some extent,CT is an effective method for assessing the effect of BAI by determining the size and density of primary tumor and mediastinal lymph nodes ,but it is limited in predicting the pathological changes after therapy.